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143 Cards in this Set

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ability to know and think, using intellect, logic, reasoning, memory, and all of the higher cortical functions. Allows people to interact with others and negotiate daily life. Thus, appropriate communication and comprehension depend on speech/language abilities, absence of thought d/o, and brain fuctions relating to cognition and intellect, including language, memory, attention, perception, judgment, reasoning, and recognition.
MSE 121, 159
Types of deficits affecting cognition and their clinical correlations
Deficits in attention, memory, visuospatial ability, abstraction, Disorders include delirium, stroke, tumor, radiation necrosis, MS, HD, parkinsonism, Alzheimer's, head trauma, chronic alcoholism, infections, MR, learning disabilities.
MSE 121
Intelligence - appraisal during psych interview
Intelligence is a dimension of cognitive ability. Only a gross estimate can be obtained during a psych interview. Can rely on pt's verbal abilities as a clue to verbal intelligence. If pt has graduated from college, can assume he is of at least average (100) IQ, though converse is not true. In presence of other cognitive deficits, intelligence testing may not be possible.
MSE 122
Cognition and competence
If cognition is not intact, pt may not be fully competent to make medical/psych decisions. Competency involves not only intact cognition as a basic condition, but also an ability to comprehend the risks/benefits and consequences of an intervention
MSE 122-3
Cognitive decline in the elderly - what skills are lost early? Late?
The elderly tend to retain verbal skills better than so-called performance skills, such as visuomotor tasks and speed of performance. Have particular difficulty with timed tasks, and may perform them accurately if allowed more time. Few cognitive tests have normative values derived exclusively from/for older persons.
MSE 124
Cognitive testing - basic/initial
Can obtain some cognitive info from routine history taking, e.g. if pt remembered time/date/location of appt, likely to be oriented and have prospective memory intact. If pt does not know age, address, # years married, ages of children, demographic info, then cognitive impairment present.
MSE 124
Cognitive testing - what to ask if pt doesn't know year
ask pt's year of birth and age, and then ask "if you were born in1918 and you are 75 years old, then what year does that make it now?" This tests calculation and abstraction abilities.
MSE 124
Cognitive testing - asking in a sensitive fashion
This is especially important in case of dementia - pt may get defensive and hostile when confronted with cognitive decline, may become uncooperative. Can weave questions into history to test memory
MSE 124-5
"Cognition grossly intact"
Can say this when information from rest of history leaves examiner feeling confident of pt not having cognitive impairment. Should also write, "Cognition not formally tested"
MSE 125
Cognitive testing in pt with language deficits
Especially in deficit w/ comprehension (e.g. Wernicke's). Bypass verbal comprehensive/expressive language, e.g. Gestures, mimicry to describe tasks. Designs/objects can be used to test memory. Jigsaw puzzles can be used to assess problem-solving skills. Attention span - pointing to a series of written numbers. Referral to neuropsychologist for futher testing
MSE 125
Prefacing cognitive testing to avoid awkwardness
Don't say, "These are easy questions," because pt may be more impaired than is initially evident, and may feel worse for failing test then. Say, "I ask all my patients these questions. It's to test your memory and concentration. Have you noticed any problems with getting distracted or forgetting things?"
MSE 125
Cognitive testing sequence - 6 steps
1. Orientation 2. Attention/concentration 3. Registration and short-term memory (verbal and non-verbal) 4. Long-term memory (verbal and non-verbal) 5 Constructional and visuospatial ability 6. Abstraction and conceptualization
MSE 126
Disorientation - order of loss of orientation
Time lost first, then place, then person.
MSE 126
Orientation to time - testing
test by asking time of day,day of week, month, date of month, year, and season. Hospitalized patients should be clear on what part of the month it is.
MSE 126
Orientation to place - testing
ask pt name of hospital or clinic and floor. Ask city and state in which interview is taking place
MSE 126
Orientation to person - testing
to one's self, one's family, friends, those in contact w/ patient in hospital or clinic. Impairment usually begins with those least well known to the patient: the nurses, doctors, therapists. Names/functions may be forgotten, or they may be more commonly misidentified as hotel staff, old friends, torturers. Next, more familiar persons, e.g. neighbors, may be misidentified. Finally, pt may no longer known own identity - grave sign in delirious pt.
MSE 126
Disorientation - clinical correlations
MC in confusional states and severe amnestic syndromes. Also extensive damage to prefrontal cortex (usually b/l). Transient global amnesia, an unusual condition, involves tmporary disorientation and memory deficits, possibly related to temporal lobe dysfunction. Moderately to severely dementia. Sedation. Damage to frontal lobes from Trauma/surgery. Conversion, factitious disorders.
MSE 126-7, 161
Attention and concentration - relationship
Attention is ability to focus and direct cognitive processes while in a physiologically aroused state. Concentration is the ability to focus and sustain attention for a period of time.
MSE 127
Attention - contributing brain regions
Brainstem reticular activating system provides arousal as a precondition to attention. Subcortical areas such as cingulate gyrus, parts of thalamus, ascending noradrenergic, dopaminergic, and cholinergic brainstem pathways act w/ prefrontal cortex and nondominant inferior parietal lobe to subserve attentional functions.
MSE 127
Intact attention, impaired concentration
Is possible, even though the two are related. As in Alzheimer's Dz
MSE 127
Aspects of attention
include visual, auditory, verbal. Need to test each of these
MSE 127
Attentional testing - Reasons for impairment
pts who are agitated and generally distractible, anxious, sleep-deprived, actively psychotic, in pain, children with ADD. Deficits likely, especially in concentration
MSE 127
Attention/Concentration - examples of tests
Trail-making tests, Symbol Digit Test, Mesulam's Cancellation Tests, Stroop Color-Word Test
MSE 127
Digit Span
Attentional test. Digits recited to pt in series of increasing lengths. Pt to repeat aloud (writing not allowed). Recite in monotone, with last digit in lowered pitch (indicating end of series), slowly, clearly, one-second intervals. Until pt makes mistake. Do in reverse too, starting w/ two numbers.
MSE 128
Digit Span - normal results, significance of abnormal results
Forward - 6+/- 1 digit. Usually 1-2 higher than backward span. If backward is more than two fewer than forward - abnormal, implies impairment with problem in divided attention (attending while distracted by another mental task, as in changing order)
MSE 128
Digit span - clinical correlation of abnormal results
impaired in delirious, moderately demented, frontal/subcortical-lesioned patients, who may perform normally on the forward span but do poorly on backward span. L frontal lobe dysfunction can shorten forward digit span. Abulic pts perform slowly, may not complete task.
MSE 128
Visual attention testing
involve pictures w/ items, such as birds, hidden w/in a scene. Pt asked to point to and count aloud each bird he or she can find in the picture.
MSE 128
Concentration testing - in elderly
Can ask pt to count backwards from 65 to 49. Don't repeat instructions once started. Inattentive pts will continue past 49 or lose track of task. Good in elderly, in whom serial sevens may be too sensitive to effects of normal aging
MSE 128
Serial sevens
Concentration test. Look for maximum 5 correct. If pt makes mistake but then continues from there, correctly subtracting 7 each time, consider those correct responses. Consider results in context of educational background (also, may be too difficult if <=8 yrs education)
MSE 128
Serial sevens - Alternatives
Can subtract 7s from 101 or 13s from 100. Can subtract 3s from 20. Can add 3s to 1. Can do WORLD or EARTH backward. Letters must be in correct position to be correct. Can recite days/months backward
MSE 129
First step in learning. Capacity for immediate recall of new learning. Lasts only a few seconds. variously considered to precede memory or be the initial component of short-term memory. Prefrontal cortex probably plays an important role
MSe 129, 162
Short-term memory - characteristics, requirements
precedes consolidation of long-term memories, occurs successfully only if attention to and registration of information precede it. Short-term memory is temporary, lasting from seconds to a few minutes. Can be used immediately in decision making and/or passes into long-term memory. Limited capacity.
MSE 129-30
Two types of long-term memory
Procedural and declaritive
MSE 130
Procedural memory
Type of long-term memory. Involves remembering how to perform a set of skills, like driving, riding bicycle. After initial practice/mastery, these become implicit (not in conscious awareness).
MSE 130
Procedural memory - in amnesia
This remains intact in most amnestic patients, both for previously learned skills and for learning new skills. Phylogenetically old and not affected by dysfunction of temporal lobe-diencephalic areas known to be important for other types of long-term memory
MSE 130
Declarative memory
Part of long-term memory, affected in amnestic patients, involves data or facts that can be verbal or nonverbal. Explicit - remembered information should be retrievable into conscious awareness, unless there is damage to brain areas involved in storage/retrieval (i.e. amnestic syndrome) or there is a psychologic defense mechanism interfering (e.e. repression, dissociation, denial)
MSE 130
Declarative memory - brain regions
Phylogenetically more recent, located in medial temporal lobe, hippocampus, diencephalon, ventromedial frontal lobe. Continues to be consolidated over time, or can decay over time. Hypothesized that various types of short-term memory (verbal, visual, auditory) are located in same brain areas as their long-term counterparts. Medial temporal particularly important during learning, and for consolidation. Retrieval from LT memory involves coordination b/w medial temporal area and various storage sites in the cortex.
MSE 131
Retrograde amnesia
loss of LT memories that were consolidated prior to insult or event producing amnesia
MSE 131
Anterograde amnesia
loss of ability to learn, store, and retrieve memories subsequent to insult
MSE 131
Amnesia in head trauma
often have some degree of retrograde amnesia, usually for hours or days prior to accident, as well as anterograde amnesia for information about accident and from a period after trauma that lasts for hours or days. In some cases, anterograde amnesia extends indefinitely - becomes amnestic syndrome.
MSE 131
Memory - Korsakoff's
diencephalic dysfunction w/ profound anterograe LT memory deficits and variable retrograde amnesia (often remote memories are intact), but w/ preservation of registration and ST memory. Thus, able to recall newly presented information for a few seconds or minutes, not hours or days.
MSE 131
Memory - [non-]Dominant temporal lobe lesions
dominant - predominantly affect verbal memory; nondominant lesions affect visual memory
MSE 131
Memory - temporal lobe lesions
b/ cause more severe amnesia than unilateral; greatly impair new learning (anterograde memorY). Attention span is normal, however, as is ST memory, and recent LT memory often more impaired than very remote LT memory (retrograde amnesia)
MSE 131
Memory - other causes of b/l lesions and amnesia
viral encephalitis (commonly herpes), infarctions due to posterior cerebral artery compromise, and hypoxia (e.g. cardiac arrest or CO poisoning); anoxic encephalopathy, diencephalic damage following rupture anterior communicating artery aneurysm, tumors of 3rd ventricle can also produce amnestic syndrome
MSE 131, 158
Pseudodementia vs. dementia - findings
Pseudodementia - term used in describing pts whose memory deficits are presumably due to physiologic perturbations associated w/ psychiatric disturbance, rather than structural brain damage. Show pattern of "spotty" deficits and inconsistent performance on most memory testing, related to attentional deficits and inconsistent motivation. Truly demented pts have difficulty with LT memory, usually more than w/ remote info, until later in dz, when both are impaired.
MSE 131
Memory - frontal lobe damage
deficits in temporal memory (or prospective memory), which is remembering to remember. Not consequence of true amnesia, but related to inability to shift mental sets from one topic to another in order to focus on newly presented information and then remember it, and to deficits in planning and organization abilities. Can affect orientation. W/ sufficient focusing and rehearsal, can remember information once volitional/motivational impairments overcome
MSE 131
Registration - testing
via immediate recall (within seconds). Repeat three words that will be tested again in a few minutes. Note number of trials needed. More than two suggests inadequate registration. Particularly important to determine if registration has occurred in inattentive, poorly motivated, or depressed pts
MSE 132
Short Term Memory - testing
Present 3-4 unrelated words to be remembered after five minute delay. Check for registration, then do rest of MSE, then test ST memory. Note how many words remembered, and prompt with category (if word is brown, say "it's a color"), and then with a list of words if necessary. No points for word recalled after cuing, but note that cuing was helpful.
MSE 132-3
Short Term Memory - testing, alternate
Can read a paragraph long vignette aloud. Preface by explaining to the patient that he/she will be expected to retell the story from memory. E.g. George/ is a TV / news reporter. / He was covering an earthquake / in LA. / He interviewed / a woman / named Carol / whose car / was parked on a street / which caved in / during the tremors. / The car / disappeared / into the earth. 15 ideas expressed. Normal is >=8
MSE 133
Word List Recall
Tests ST memory. Read aloud at 1word/sec rate, 15 related words and 15 unrelated words, with immediate repetition by patient. Do twice (different order for second trial. One point for each correct. Sum both trials for each list. Can ask again after 20 min for LT verbal memory
MSE 133-4
Word List Recall - example
List A: Dog, Chicken, Horse, Cat, Elephant, Book, Magazine, Newspaper, Pamphlet, File, Knife, Dish, Pan, Spatula, Grill
List B: Vacuum, Truck, Movie, Conference, Envelope, Fire, Election, Moon, Refrigerator, Shovel, House, Lemonade, Town, Wallet, Lamp
MSE 133-4
Word List Recall - Significance of results
Normal - 16 or more for each; similar performance in related/unrelated lists. Amnestic - do not group words of category together, perform similarly on both. Depression-induced pseudodementia - fairly well on A, less well on B b/c of reduced motivation/impaired attention to more challenging task. True dementia - poorly on both
MSE 134
Nonverbal Short Term Memory - Testing
Visual ST memory - test by showing pt picture of six simple designs for five seconds, and then have them draw what they remember.
MSE 134
Nonverbal Short Term Memory - Testing, addressing confounding factor
Drawing is involved, so visual or visuospatial deficit might interfere w/ ability to test this memory. Have a trial to simply copy designs following the failed recall trial. Alternatively, can choose several drawings from larger list, e.g. Mesulam's Three Shapes Test.
MSE 134
Auditory Short Term Memory - Testing
Tap out pattern of loud and soft sounds and ask pt to repeat. Start with simple patterns and progress to more complicated ones.
MSE 134
Long Term Memory - time periods
Recent and remote. Remote is from many years ago, e.g. from childhood.
MSE 135
Long Term Memory - subtypes of declarative long term memory
episodic and semantic
MSE 135
Episodic Memory and its testing
these are time tagged, personalized, and experiential knowledge. Pt asked to describe important personal events, such as a wedding, PMH, etc., and to identify when these occurred. Examiner should verify from other sources data gathered.
MSE 135
Memory - confabulation
Be wary of this. Pts with memory deficits may go on and on with interesting stories with no basis in fact. Particularly grandiose/unbelievable stories may indicate spontaneous confabulation
MSE 135
Semantic Memory and testing
Involves recall of general information that a person could reasonably be expected to have learned. E.g. name of last five presidents, when did WWII end, what famous college is in Cambridge MA, where do Steelers play? Or can ask pt to list as many items from grocery store as possible in one min. Normal is at least 18 different things
MSE 135-6
Constructional ability - prerequisites
Prerequisites are intact vision, motor coordination, strength, praxis, and tactile sensation. Those who fail construction tests should be tested for other d/o inc. visual deficits, writing apraxia, and visual agnosia. Vision tested by Snellen and confrontational visual field test. Then test writing ability.
MSE 136
Constructional ability and visuospatial function - needed for?
driving, maneuvering in kitchen to cook, use a computer, vacuum a room, climb the stairs, read a map, solve mazes, etc. Even so, pts may not be able to specifically describe deficits. May complain of not recognizing previously familiar faces, no longer being able to knit, do puzles w/ children, etc.
MSE 136
Constructional ability - brain regions
nondominant hemisphere is particularly important for visuospatial function, both have capacity for imagery, both contribute to visuoconstruction. ND hemisphere, esp. parietal area - perceive overall form or Gestalt. D hemisphere discerns detail.
MSE 136-7
Constructional/visuospatial testing- L hemisphere impairment
typically draw coherent by simplified image w/o details but w/ correct overall spatial orientation/relations.
MSE 137
Visual agnosia - constructional testing deficits
may make it difficult for pts to recognize things visually, though they can feel and identify object. May confound visuospatial testing.
MSE 137
Posterior parietal (e.g. Alzheimer's) - effect in construction testing
alters constructional ability.
MSE 137
Constructional/visuospatial testing - Right Hemisphere deficits
loss of spatial relations, incorrect orientation, scattered and fragmented components, new lines added to correct drawing.
MSE 137
Constructional testing - example
Draw 3D cube or intersecting pentagons. If too difficult, move to simpler shapes, e.g. trianges, circles, squares. Pattern of alternative shapes (i.e. graphomotor sequences - line that includes alternating tops of circles and triangles) can detect motor perseveration. If too difficult, have pt draw its simpler components, the circle and triangle.
MSE 138-9
Clock drawing - anosognosia
pts w/ neglect may only draw one side, or squeeze all parts onto one side. If given a pair of gloves, may only put one on.
MSE 139
Clock drawing - visuospatial defects
space numbers unevenly, put them outside the circle, or otherwise distort clockface. hands may not point ot correct time
MSE 139
Clock drawing - perseveration
Motor perseveration may impede finishing task, w/ pt stuck in one area, drawing it over and over.
MSE 139
Clock drawing - hemispheric contributions
LH - contributes to capacity to draw details like position of hands and size of numbers. RH perceives rotatiosn or distortions of whole shape or layout and spatial relationship and proportionality among components
MSE 139
Clock drawing - what to test if severely impaired in this
May need to test separately ability to write numbers or to count out loud.
MSE 139
Hooper Visual Test - purpose, brain regions
example of using a puzzle to test constructional ability. Pt has to imagine what whole object would look like without moving the pieces. RH and frontal lobe functions important in performance of this test.
MSE 139
Match figures - cognitive testing
Can use red-tipped matchstick figures and have pt replicate designs. Shape and subtle positioning of red tips should be replicated. If done after delay, LT visual memory tested.
MSE 139
Map drawing
Can test visuospatial function and general information (semantic memory) at same time. Have pt draw map of US and label NY, SF, Boston, Miami, Dallas, Chicago, San Diego. Alaska and Hawaii should not be forgotten. Proportions and shape should be proper. Cities and oceans should be located. Allow for tremors, chorea, etc.
MSE 139-41
Frontal lobe functions
Involved in attention, prospective memory (remembering to remember), conceiving and organizing for the future (tmeporal relationships), motivation, spontaneity, creativity, abstract thought, ability to initiate activity, executive functions
MSE 142
Executive functions - what are they, brain region?
regulate complex and novel thinking, judgments, and behaviors. Frontal lobe. in dominant hemisphere, frontal lobe also imporatnt for language, e.g. Broca's area
MSE 142
Prefrontal cortex - importance
part of an interconnected cortical and subcortical network that includes association areas in the temporal and parietal lobes, limbic regions, and subcortical nuclei. Thus, deficits in executive functions can occur because of lesions or degeneration of basal cholinergic and midbrain dopaminergic nuclei, caudate nuclei, or medial dorsal thalamic nuclei, or because of multiple subcorctical white matter lesions that disrupt corticocortical connections, or multiple cortical lesions outside the frontal lobe.
MSE 143
Executive functions - other deficits that can interfere with this
Memory, attention, visuospatial ability integrate with frontal executive ability in production of abstract thinking and sophisticated conceptualization. Deficits in any of these cognitive abilities, or in language, can affect executive functions.
MSE 143
Abstract thinking
capacity to conceptualize menaings of words beyond literal (concrete) interpretation. Includes ability to analyze info according ot themes, generalize according to categories, appreciate double meanings, make comarisons, hypothesize, and to reason using deductive and inductive thinking. Corresponds to Piaget's formal operations
MSE 143
Abstract thinking - what affects this?
education, intelligence, cultural factors, developmental level in children.
MSE 143
Abstract thinking - Hemispheric contributions
L - capacity to formulate verbal concepts, using rules of hierarchy and logic. R - capacity to appreciate an overall, integrated image of the spatial , emotional (e.g. humor) and practical components.
MSE 143
Abstraction - assessment
Identifying similarities and interpreting proverbs are common ways
MSE 143
Similarities testing
abstraction testing. ask pt ot conceptualize categories to which two belong. Apple/orange/fruit, car/boat/modes of transport, shirt/coat/clothing, table/chair/furniture. Dog/tree/living (to say they both have bark is literal, almost a pun)
MSE 143
Proverb interpretation
test for abstraction. Also measures divergent reasoning. Proverbs are intrinsically significant when generalized or abstracted, rather than in literal interpretation.
MSE 143-4
Proverbs - simple examples
The grass is greener on the other side (Things that seem better elsewhere are not necessarily so) Don't count your chickens before they hatch (Don't be prematurely expecting something that might not happen), A stitch in time saves nine (take action today to avoid consequences or complications tomorrow)
MSE 144
Proverbs - more difficult examples
Rome wasn't built in a day. People who live in glass houses shouldn't throw stones. Loose lips sink ships. Every cloud has a silver lining. A rolling stone gathers no moss.
MSE 144
Proverb - testing (initial)
First explain to pt that a proverb is a saying with a broader meaning. Start by finding an example of which the pt has already heard, e.g. save for a rainy day. Then proceed with easy and progressively harder proverbs as pt correctly interprets them.
MSE 144
Proverbs - significance of inability to interpret
Possible explanations - inadequate education (<8 years), acute psychosis, dementia, delirium, head injury, frontal lobe damage, low IQ (including MR), and lack of cultural applicability of proverb. Easy proverbs and interpretations are often memorized by patients who cannot reason out unfamiliar ones.
MSE 144
Switching Mental sets
Test of conceptualization. E.g. b/w letters and numbers (Trailmaking B test) or b/w symbols and numbers (Stroop test) or between motor tasks. This can be tested by having pt squeeze examiner's hand whenever he/she says "green" and to relax when he/she says "red" - a Go-No go paradigm. Impulsive and prefrontal cortex-lesioned pts are particularly apt to make errors of omission, commission, and perseveration on such tasks.
MSE 144
IQ Testing - WAIS, changes with aging, factors making performance difficulties > verbal difficulties
Wechsler Adult Intelligence Scale. Its info and vocab subtests are believed to be good indicators of premorbid intellectual abilities. Verbal aspects of intelligence may remain relatively constant through aging. Performance aspects appear more vulnerable to effects of aging, as well as to conduct d/o, alcohol abuse, head trauma, etc. Normally the two subscores should be w/in ten points of each other. With aging and these disorders, the spread can increase.
MSE 145-6
IQ testing - WAIS - verbal difficulties > performance difficulties
Can be worse in ADHD, in some conduct d/o pts (perhaps the inadequate verbal skills make them more likely to "act out" their feelings in the form of behavioral problems rather than to think/talk through their feelings/frustrations). Dyslexics do worse on many verbal subtests than performance ones.
MSE 146
Mini-Mental - limitations
Max score = 30. Normals average 28. 24 or less is abnormal, indicating diffuse cognitive dysfunction. Less sensitive than specific. Abnormal score highly suggests that a problem is present, but pts with milder forms of delirium or dementia may score 25 or more points. This kind of false positive more likely in highly intelligent pts with early dementia. Low scores in pts with <8 years education require cautious interpretation.
MSE 146
Mattis Dementia Rating Scale - use, limitations
screening test for pts expected to be incapable of performing challenging tests, e.g. demented or brain-injured pts. Max 144 pts. <124 usually considered abnormal. Total score less informative than five subscores: attention, construction, memory, initiation/perseveration, conceptualization. Deficient in language problem screening. Stronger in testing visuospatial abilities, memory, attention. Tests for perseveration. Assesses conceptualization using similarities and other abstraction tasks. Saves time by placing most difficult test in any section first.
MSE 146
Trailmaking Tests Parts A and B; use? purpose? upper limits of normal? Part B is especially sensitive in detecting what?
Screening test for sustaining attention. Also assess visuospatial and motor integrative functions and cognitive flexibility (probably prefrontal cortex function), both of which are required to switch quickly from numbers to letters. Timed in seconds. Different norms for different age groups. For adults <70, 34s is upper limit for normal in Part A, 89 for part B. Part A is just number, Part B numbers and letters. Part B is especially sensitive in detecting diffuse cognitive dysfunction.
MSE 148-9
Symbol Digit Modalities Test
Test of concentration. Has a key made of a row of symbols corresponding to numbers 1-9. Timed test testing accuracy of translating symbols into numbers in 90s. Pts who can't write can say numbers aloud. Normative scores for age groups, as education and age affect scores
MSE 149-51
Stroop Color-Word Test
Challenging test of selective attention and concentration. First page - color words. Second - xx's in different colors. Third - color words in non-matching color ink. Pt has to read as many words (first page) and colors (2-3 pages) as possible in 45 seconds. Impulsive patients make many errors. Alternate administration/scoring system = timing how long it takes to correctly read 100 items.
MSE 151-2
Rey-Osterrieth Complex Figure
Test of constructional ability and visual memory. Also evaluates organization and perceptuomotor skills. Pt asked to copy as accurately as possible in 5min. How drawing is begun and executed is observed.
MSE 152
Rey-Osterrieth Complex Figure - normals vs. brain-damaged, R hemispheric lesioned
Normals notice large rectangle, draw it, subdivide it, then add details, b/c this keeps design proportionate. Brain-damaged pts usually have a great deal of difficulty copying the drawing. R hemisphere lesions - miss overall form and focus on smaller details, drawing disproportionate figure. Severely brain-damaged pts, esp. those with non-dominant hemisphere lesions, will draw something w/ little or no resemblance to design.
MSE 152
Rey-Osterrieth figure - memory testing
Can ask pt to redraw design after brief delay. This recall task is sensitive to non-dominant temporal-lobe dysfunction. Tests ST visual memory. After 30 minutes, tests LT visual memory. Specific scoring for this test found in Spreen and Strauss (1991)
MSE 152-3
Mini Object Test
used to test for anomia, agnosia, apraxia. Uses children's game Jack Straws - miniature plastic objects including wrench, pitchfork, ladder, rifle, paddle, shovel, ax, and saw. Pt asked to name each and demonstrate how it should be used. If pt can't visually recognize, allowed to feel it. 30 point scale. Differentiates demented from depressed/schizophrenic pts. Can be useful in naming portion of language assessment.
MSE 153
Mini Object Test - anomics
impaired in naming objects, though can demonstrate their use
MSE 153
Mini Object Test - Agnosics
Can neither recognize nor describe use of objects
MSE 153
Mini Object Test - Apraxics
Can name and describe use of objects, but can't demonstrate
MSE 153
Cognitive test results - only memory defects
perhaps amnestic syndrome, early dementia
MSE 156
Cognitive test results - mostly attentional deficits, inconsistent performance performance w/in even a particular area
motivational problem, e.g. depression-induced pseudodementia, mild/subclinical delirium
MSE 156
Cognitive test results - many different areas of impairment, inc. orientation, attention, calculations, working memory, LT memory
consider delirium, dementia
MSE 156
Cognitive test results - older person w/ difficulty naming objects, memory deficits, visuospatial problems in drawing or constructional tasks
suggests early Alzheimer's dementia
MSE 156
Cognitive test results - inattention on most tasks and short attention span
suggest attention deficit disorder
MSE 156
Abstraction impairment - lesions where?
prefrontal cortices and/or their subcortical connections in the basal ganglia and thalamus
MSE 157
Inability to recognize an object or a nonverbal symbol even though primary sensory pathways, e.g. vision and hearing, are intact. Perceptual problem, not verbal. Can't comprehend object's function, even though it was previously familiar. Can be visual, tactile, auditory, for faces, colors. Differentiate from anomia
MSE 157
Agnosia - responsible lesions?
finger, color and visual-object agnosia caused by lesions in L hemisphere
MSE 157
Neural basis of memory function
Not completely understood but probably involves temporal lobes, frontal lobes, and limbic system, w/ ascending connections from brainstem.
MSE 157
Memory - affect of concussion
produces retrograde and anterograde amnesia, which may be only temporary
MSE 158
Amnesias - differentiate from?
Differentiate amnesias from structural/physiological causes from hysterical causes, e.g. conversion d/o and fugue states, and from psychologic repression of a memory
MSE 158
Deficit in attention (distractibility) causes
include delirium, depression, fatigue, drug intoxication, ADD, stroke, head trauma, anxiety, and dementias
MSE 158
Attentional mechanisms - neuroanatomy
involves ascending brainstem pathways, cingulate gyrus, thalamus, frontal lobes, parietal lobes
MSE 158
Calculation ability - requires?
ability to understand and utilize mathematical constructs and symbols, in contrast to verbal symbols and words. Calculating requires visual and cognitive recognition of symbols and figures, remembering tables of mathematical procedures, and sequencing the order of numbers
MSE 158
acalculia (dyscalculia)
inability to solve mathematical problems
MSE 158
localization of acalculia
depends on deficit involved: disturbed spatial ability, difficulty appreciating numbers as symbols, comprehension problems, etc. L hemisphere lesions cause dyscalculia related to loss of arithmetic sense or alexia. R cause dyscalculia related to loss of spatial relations sense
MSE 158-9
Concentration deficits - causes, lesions
can be impaired by organic brain dysfunction, depression, head injury, any conditions that disrupt attentional ability. It can be affected by damage to the parietal and frontal lobes, cingulate gyrus, and ascending brainstem neuronal pathways.
MSE 159
Concrete thinking is normal in?
latency-age children (pre-pubertal)
MSE 159
Concrete thinking - seen in?
pts with schizophrenia, MR, delirium, dementia, frontal lobe damage
MSE 159
Spontaneous confabulation - characteristics? cause?
One of two types of confabulation (other is provoked). Wide-ranging and grandiose, resembles delusions, occurs w/ severe lesions of frontal lobes.
MSE 159
Provoked confabulation - characteristics? causes?
one of two types of confabulation (other is spontaneous) - in response to questions about forgotten information. Occurs w/ lesions of temporal and limbic areas
MSE 159
Confabulation - differentiate from?
fluent aphasia
MSE 159
Confabulation - lesions
damage to temporal lobes, frontal lobes, and limbic system/thalamus, or to pathways that interconnect them. Tumor, stroke, aneurysm, and chronic alcohol abuse are common causes
MSE 159-60
Constructional ability, lobar/hemispheric contributions
ability to draw, construct, or manipulate shapes and figures in 2D and 3D. Requires integration of occipital, parietal, and frontal lobe function. L hemisphere contributes to ability to draw details or specific things. R perceives spatial configurations of whole image.
MSE 160
Dementia - definition
global deterioration of cognitive and intellectual functions. Dx, not single sign or Sx, usually involves more Sx than simply cognitive decline, e.g. personality change, mood change, psychosis.
MSE 160
Dementia - early course of diffuse cognitive dysfunction
can start with focal type of cognitive deficit, then progress to involve multiple functions. Specific early focal deficits and course vary with type of dementia
MSE 160
Cortical pattern of dementia associated w/?
cortical pathology plays a major role in Alzheimer's Pick's and multiinfarct dementias
MSE 160
Subcortical pattern of dementia associated w/?
progressive supranuclear palsy, Huntington's disease, and parkinsonian dementias
MSE 160
the ability, without looking, to perceive, recognize, and identify numbers or letters traced on the palm of the hand or palmar surface of the fingertips, through tactile stimulation. Tested separately in each hand, usually using numbers 0-9
MSE 161
Agraphesthesia - definition, significance
inability to identify numbers with graphesthesia. Soft neurological sign. If unilaterally impaired, suggests dysfunction fo contralateral parietal lobe.
MSE 161
Disorientation in psychotic pts?
Psychotic pts usually retain reasonably good orientation, unless impaired by marked disorganization of thought processes or marked preoccupation w/ delusions/hallucinations.
MSE 126-7
Pseudodementia - Causes
Generally results from inattention, concentration deficits, and/or poor motivation to perform cognitive tasks. May be named for condition causing it, e.g. depression-induced dementia or dementia syndrome of depression. Can be seen in mania and in other psych conditions, e.g. conversion, as well.
MSE 162
Soft neurologic signs
variety of motor or sensory impairments that are subtler than gross neuro impairments, indicative of CNS dysfunction, often of subcortical origin. Low specif for predicting neuro dz, often developmentally based. More often used by psychiatrists than neurologists.
MSE 163
Soft neurological signs - examples
include mirror movements, motor impersistence, agraphesthesia, astereognosis, extinction to bilateral simultaneous stimulation.
MSE 163
Soft neurological signs - use/significance
may be useful in detecting dysfunction of frontal or parietal lobes in the absence of more robust deficits, and can be combined w/ detected cognitive deficits for possible localization of neuroanatomic lesions.
MSE 163
Visuospatial ability
perceptual ability to comprehend visually relationships of designs or structures in space, and to reproduce them. Adequate visual acuity is a prerequisite
MSE 163
Steregonosis - ability, test, significance
ability to perceive, recognize, and identify objects placed in hand on basis of tactile sensing w/o seeing shape. Tested in each hand separately. Inability to perform is called astereognosis. Tests parietal lobe function
MSE 163
Word-finding difficulties, clinical correlation
inability to recall words or names of things spontaneously during conversations or during confrontational naming. Occur in Alzheimer's, anxiety d/o, various other causes of inattentiveness, e.g. sleep deprivation.
MSE 163