CORTICAL FUNCTION

Anatomy and physiology

Cortical function:
Three

major operation of neurons of the

CNS:
Reception

and registration of sensory stimuli from outside and from within. Planning and execution of complex motor act. Intermediary processing. .(thought,language,memory,self awareness,mood and affect)

Cerebral hemisphere : right and left connecting by corpus calosum

Cerebral hemisphere are divided

Primary

sensory cortex. Primary motor cortex. Association cortex. Limbic-paralimbic cortex

Cortical function : specific location Primary receptive area Secondary receptive area Association area

HIGHER CORTICAL FUNCTION

Higher Cortical Function

Coordination of external and internal factor in human being Study of the relation between brain and behavior Basic Processes :
1. 2. 3. 4. 5. 6. 7. Attention Language Memory Visual-spatial Executive Emotion Praxis

1. Evaluation
1.

The fund of acquired information or the store of knowlegde

Assessed by :
1. Simple verbal test of vocabulary 2. General information 3. Comprehension

2. Manipulation of old knowledge

Ability to apply information to new or unfamiliar situations Assessed by :

1. Calculation 2. Social comprehension

3. Social awareness and Judgement

Evaluated by :
1. Knowledge of environmental or social situation 2. Social appropriate responses in such situations and the ability to personally apply the correct response when faced with a real situation

4. Abstract Thinking
Assessed by : 1. Use of proverbs 2. Conceptual series 3. Analogy interpretation

Memory

Involves :
1. Recognition 2. Registration 3. Recall Retrieval

Anatomical basis of memory Hippocampus

The Anatomical Basis of Memory

Test of Memory
1. Immediate memory 2. Recent memory 3. Remote memory

Disorder of Memory
(Amnesia Syndrome)
1. Retrograde amnesia
Impairment of memory for events that antedate illness or injury

2. Anterograde amnesia
Inability to learn new verbal or non-verbal information from onset of illness or injury

Disorders of Memory Retrieval

AAMI (Age Associated Memory Impairment) Rapid retrieval of stored memory become defective Depression disorder in motivation and concentration Subcortical dementia Slowed (but correct) response rate to questions of memory function
Senescence

Disorder of Language - Dysphasia

Language function of dominant hemisphere Emotional - Instinctive expression of feelings Symbolic or proportional thoughts, opinions and concepts depend upon culture, education, normal cerebral development

Dysphasia
Acquired

loss of production or comprehension of spoken and / or written language secondary to brain damage

Cortical Centers for Language

1. Brocas Area

Executive or motor for production of language Brocas dysphasia Motor dysphasia

Nonfluent / hesitant speech Telegraphic speech Comprehension good Handwriting - pure

Wernicks Area Receptive Area

Wernicks dysphasia :

Comprehension Impaired Speech fluent but nonsensical Neologism Paraphasia half right words Patient unaware of language problems Hand writing poor

Global Dysphasia
Non-fluent

speech Comprehension impaired

Receptive and expressive areas linked by arcuate fasciculus in order to integrate function
Conduction
Speech

Dysphasia

nonsensical but fluent Comprehension - normal Repetition - poor

Dysphasia may developed as a result of :

1. 2.

3.
4. 5.

Vascular disorders Space occupying lesion Traumatic Infection Degenerative disorders

Mental State Examination

Mini

Mental State Examination. Score 0-30

0-10 0-3 0-5 0-3 0-8 0-1

Orientation

(time.place) Memory registration Attention and Concentration Memory Recall Language Visual-patial

Orientation
1.

Ask the patient : What is this year, season, date, day, month? Score 5 Ask : Where are you? State, country, town, place, floor (or ward) Score 5

2.

Memory Registration
3. Tell the patient that you want him /her to remember something for you, then name three unrelated objects (speak clearly and slowly). Ask the patient to repeat the three objects
Score 3 points; if correct first time, Score 2 points; if correct second time Score 1 point: if correct third time Ask the patient to keep the three things in mind

Score 3

Attention and Concentration

4. Ask the patient to take seven from 100, then seven from the result, and so on for five subtractions. Score 1 point for each correct answer or Ask the patient to spell world backwards, and score 1 point for each correct letter Score 5

Memory Recall
5. Ask the patient to recall the three objects from test 3 Score 3

Language
6. Show the patient two familiar objects (e.g. a pen, a watch) and ask him/her to name them Score 2 7. Ask the patient to repeat a sentence after you: No ifs, ands or buts Score 1 8. Ask the patient to follow a three-stage command: Please take this paper in your left hand, fold it in half and put the paper on the floor Score 3 9. Ask the patient to read and follow a written instruction, e.g: Close your eyes Score 1

Language (cont)
10. Ask the patient to write a simple sentence. The sentence should contain a subject and a verb and should make sense Score 1 11. Ask the patient to copy a picture of intersecting pentagons Score 1

Total Score
A

30

score below 24 indicates probable cognitive impairment A score below 17 indicates definite cognitive impairment