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. Attention
2. Language
3. Memory
4. Visuospatial
5. Emotion
6. Praksis
Cerebral hemisphere : right and left
connecting by corpus calosum
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 Language - Dysphasia

Language function of dominant

hemisphere
Emosional - Instinctive expression of
feelings
Symbolic or proporsional 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 Dysphasia
Speech nonsensical but fluent
Comprehension - normal

Repetition - poor
 Dysphasia may developed as
a result of :
1. Vascular disorders
2. Neoplastic
3. Traumatic
4. Infection
5. Degenerative disorders
Mental State Examination
Mini Mental State Examination
Orientation

Memory registration
Attention and Concentration

Memory Recall

Language

Visuospatial
Orientation
1. Ask the patient : What is this year,
season, date, day, month?
Score 5

2. Ask : Where are you?

State, country, town, place, floor (or
ward)
Score 5
 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 substractions. 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 30
A score below 24 indicates probable
cognitive impairment
A score below 17 indicates definite
cognitive impairment