Neuro - Examination Of Cognitive Function

Front 1

Components of the mental status exam

Back 1

Level of consciousness

Attention/concentration

Cognitive functions - Language, memory, construction, calculation, interpretations of sensory input, performance of complex learned activities, executive function

Affect

Thought processes

Thought content

Front 2

Dementia

Back 2

Deter. of intellectual or cognitive function (partic memory).

No change in alertness of perception.

Front 3

Aphasia/Dysphasia

Back 3

Language impairment.

Front 4

Agnosia

Back 4

Inability to understand the import of sensory stimuli despite intact sensory mechanisms.

Front 5

Apraxia

Back 5

Inability to perform learned actions despite intact motor function.

Front 6

Aprosody/Dysprosody

Back 6

Impairment of the use and understanding of inflection.

Front 7

Semantic (verbal) Paraphasia

Back 7

Substitute wrong word.

Production of well articulated but incorrect words.

Front 8

Phonemic (literal) paraphasia

Back 8

Substitute wrong sound.

Production of well articulated but incorrect words.

Front 9

Neologism

Back 9

Non-existent word.

Front 10

Broca's area

Back 10

Frontal lobe - anterior to motor strip.

Pt becomes very frustrated.

Front 11

Wernicke's area

Back 11

Superior temporal gyrus

Front 12

Arcuate fasciculus

Back 12

White matter tract connecting Broca's and Wernicke's.

In anterior-inferior parietal lobe.

With lesion, unable to repeat things.

Front 13

Non-dominant hemisphere

Back 13

Helps process emotional/nuances and musicality of language.

Lesions would cause dysprosody and linguistic agnosias.

Front 14

Aphemia

Back 14

Inability to produce speech despite intact comprehension, reading, writing.

Front 15

Wernicke's aphasia

Back 15

Lack of concern. Often in the setting of R superior quadrantanopsia (can't see top right corner of field of vision).

Hard to rehab these pts.

Front 16

Broca's aphasia

Back 16

Usually in the setting of R hemiparesis (weakness of that side of the body).

Easy to rehab these patients.

Front 17

Word deafness

Back 17

Can't comprehend words. Poor repitition but normal fluency, naming, reading, writing.

Front 18

Conduction aphasia

Back 18

Can't repeat bc interruption in arcuate fasciculus. Fluent, paraphasias. Comprehension may be OK.

Front 19

Global aphasia

Back 19

Can't comprehend, produce or repeat speech. Loss of Broca's, wernickes and arcuate fasciculus.

Front 20

Transcortical motor aphasia

Back 20

Broca's with good repitition

Front 21

Transcortical sensory aphasia

Back 21

Wernicke's with good repitition.

Front 22

Transcortical mixed aphasia

Back 22

Global aphasia with spared repitition

?so it is lesion of Broca's and Wernicke's?

Front 23

Anomic aphasia

Back 23

Inability to name with normal fluency, repitition, comprehension.

Front 24

Aphemia location

Back 24

Broca's area or prefrontal cortex

Front 25

Broca's aphasia location

Back 25

Inf precentral gyrus

Front 26

Wernicke's aphasia location

Back 26

upper posterior temporal

Front 27

conduction aphasia location

Back 27

inferior parietal

Front 28

global aphasia location

Back 28

large area in parietal and frontotemporal

Front 29

transcortical motor aphasia location

Back 29

frontal (just superior to brocas area)

Front 30

transcortical sensory aphasia location

Back 30

temporal
(just posterior to wernicke's area)

Front 31

transcortical mixed aphasia location

Back 31

anterior and posterior border zones

Front 32

Anomic aphasia location

Back 32

Left hemisphere - temp-parietal?

Front 33

Pure word deafness location

Back 33

Superior temporal gyri.

Front 34

Subcortical aphasia
head of caudate lesion

Back 34

Poor comprehension

***Caudate = comprehension; thalamus=talkativeness***

Front 35

Subcortical aphasias
Thalamic

Back 35

Logorrheic (incomprehensible talkativeness).
Good repitition

Front 36

Declarative memory

Back 36

Episodic and Semantic

Front 37

Episodic memory

Back 37

Memory of events. Med temporal (bilateral), hippocampus, mamillary body. Easy to lose these.

Front 38

Semantic memory

Back 38

Knowledge of concepts. Cortical association areas. e.g. algebra problem. hard to lose these.

Front 39

Non-declarative memory

Back 39

skills, habits. procedural (Basal ganglia - think apraxia) or conditioning/priming (amygdala)

Front 40

Working memory (short-term)

Back 40

Several seconds of storage. Frontoparietal regions.

Front 41

Calculation location

Back 41

Dominant angular or marginal gyri.

Front 42

Acalculi

Back 42

Generally dominant parietal lobe or frontal lesions.

Angular gyrus lesion - memorized multiplication tables.

Intraparietal sulcus - Greater deficits in subtraction.

Front 43

Visual agnosia

Back 43

Can still recognize with touch or sound. Lesion in bilateral parieto-occipital cortex. Pt is usually not aphasic (but wernicke's aphasia sometimes occurs)

Front 44

Anton's syndrome

Back 44

Blindness without realizing. Localization is bilat occipital. Often lateral and possibly involving parietal.

These pts can still avoid walls...

Front 45

Prosopagnosia

Back 45

Inability to recog faces. Or indiv items in a class (bird but not a robin). Lesion usually in bilateral occipital lobes.

Front 46

Simultanagnosia

Back 46

Can recog things only one at a time. Can't make the forest out of the trees. They have no context.

Commonly accompanied with Balint's syndrome (gaze apraxia-can't shift gaze, optic ataxia-can't guide hand towards an object)

Due to bilat parieto-occipital lesions.

Front 47

Asomatognosia

Back 47

Can't correctly perceive own body parts.

Lesion usually in contralateral parietal lobe or premotor cortex.

Front 48

Alexia

Back 48

Inability to read.
Often with R hemianopsia and agraphia.
Lesion in L occipital lobe.

Front 49

Alexia without agraphia

Back 49

Pure word blindness. Lesion in anterior L occip.
Disconnects wernicke's from both occipital cortices.

Front 50

Astereognosia

Back 50

Inability to recognize objects by feels. e.g. coins, pen.
Lesion in contralateral parietal.

Front 51

Agraphesthesia

Back 51

Inabil to recog numbers traced on hand. Lesion in contralateral parietal.

Front 52

Auditory agnosia

Back 52

Inabil to recog and ID specific sounds despite normal hearing.
Lesion in non-dom temp lobe.
One ex is wernicke's aphasia.

Front 53

Anosognosia

Back 53

Inabil to understand the signif of one's illness.
Lesion in non-dom parietal lobe.

e.g. unawareness of hemiparesis (due to lesion in R parietal lobe usually)

Front 54

Agnosia locations

Back 54

Usually in dominant hemisphere where the parietal and occipital come togheter.

Front 55

Neglect syndromes

Back 55

Lesion usually contralateral parietal lobe, esp R.

Ventral thalamic lesions can produce neglect too.

Visual neglext - parieto-occipital lesions.

Front 56

Agraphia

Back 56

inability to write. akin to expressive aphasia.

Often found with alexia.

Lesion usually in dominant posterior frontal cortex, but temporoparietal and temporal lesions and also produce them.

Front 57

Gerstmann's syndrome

Back 57

Agraphia, finger agnosia, L/R disorientation, acalculia.

Lesion in dominant angual gyrus and corpus callosum.

Front 58

Constructional apraxia

Back 58

Inability to copy/construct figures.
Lesion usually in non-dom parietal cortex.
Disturbance in visuo-spatial abilities rather than a pure apraxia.

Front 59

Ideomotor apraxia

Back 59

Inability to perform a specific task when asked.
Usually non-localizable.
Seen in dementia and confusional states.

Front 60

Dressing apraxia

Back 60

Lession usually in non-dom parietal

Actually a defect in visuospatial processing.

Front 61

Gait apraxia

Back 61

Gait is instinctual not learned. so this isnt a true apraxia.

Lesions are usually bilateral in frontal lobes (e.g. hydrocephalus - accum of CSF in the ventricles)

Front 62

Ataxia

Back 62

Wide-based gait, unable to tandem.

Front 63

Parkinsonian gait

Back 63

stooped, small steps, turns en bloc

Front 64

Foot drop

Back 64

High knee-lift, foot slapping

Front 65

Spastic paraparesis

Back 65

Stiff, short steps, scissoring

Front 66

Apractic

Back 66

Slow and unsteady gait, magnetic.

Front 67

Astasia-abasia

Back 67

Wildly careening without falling.

Front 68

Prefrontal cortex

Back 68

Anterior to motor and premotor cortex. Controls awareness, relevance of sensory input.
Executive functions: reasoning, abstract thinking, planning, executing, inhibiting inappropriate actions.

Front 69

Frontal lobe syndrome

Back 69

Orbitofrontal - social inapp., disinhibition, euphoria, abnormal sexual behavior, jocularity (being a jester)

Medial frontal - apathy, akinetic, abulic (indecisive)

Dorsolateral - Irritable, inflexible, reduced sexual interest, loss of exec function.

Do the stamp/mailbox test with pts. Also proverbs, planning, reflexes.

Front 70

Illusion

Back 70

misinterpretation of stimuli.
on the other hand, hallucinations are independently created.

Front 71

ideational apraxia

Back 71

inability to perform a motor task that requires a series of movements.

not localizable, also seen in dementia.

Front 72

Writing and reading with aphasias

Back 72

Writing correlates with ability to speak.

Reading correlates with ability to comprehend.

Front 73

Most common lesion to produce alexia without agraphis

Back 73

Damage to the dominant occipital lobe and splenium of corpus callosum can produce alexia without agraphia (can write but can't read).

Front 74

Which structure for short term memory?

Back 74

Hippocampus.

Front 75

Which structural lesion can lead to depression and mania?

Back 75

Depression - L frontal

Mania - R frontal.

Front 76

Noecrotex provides inhibition for...

Back 76

feeding, fighting, fleeing, sex.

these four come from limbic system.

Front 77

Do most patients with dysphasia have Broca's, Wernicke's, or a combination of both? Why is this so?

Back 77

Combo bc same vascular supply on same side.

Front 78

Angular gyrus involved in...

Back 78

word retrieval. can cause dysnomic aphasia.

Front 79

Which patient will be more motivated to recover from a hemispheric lesion, one with damage on the L or the R?

Back 79

The Left, because if it was the right, there may be anosagnosia and the pt wouldn't really recognize/care about the lesion.