Higher mental functions, Conscious level

Conscious level

1. Higher mental functions Dr Shonima Nambiar

2. Conscious level Fully conscious Drowsy : Easily arousable by touch or noise – alertness will persist for a short period Stupor : Arousable only by vigorous stimulation . Coma : Not arousable by any form of stimulus.

3. 2. Orientation to time , place and person. 3.Intelligence- Ask the patient to do simple mathematical calculations . 4.Memory : 5. Emotional labilities: Episodes of spontaneous weeping or laughing . Occurs in conditions like pseudobulbar palsy and frontal lobe disorders. . 6) Hallucinations and delusions.

4. OBSERVING THE PATIENT - CLOTHING,BEHAVIOUR, MOOD, ?ANXIOUS, LA BELLE INDEFFERENCE etc CONSCIOUSNESS: GCS SCORE ORIENTATION: TIME, PLACE AND PERSON ATTENTION AND COMPREHENSION: THREE STEP TASKS LANGUAGE AND SPEECH: APHASIA, DYSARTHRIA WORD REPETITION, NAMING, READING AND WRITING MEMORY: WORKING, EPISODIC (RECENT AND REMOTE), LEARNED, PROCEDURAL, PRIMING CALCULATIONS, ABSTRACT THOUGHTS PROGNOSIA FOR FINGER IDENTIFICATION, VISUAL AND HEMI NEGLECT PRIMITIVE REFLEXES

5. ATTENTION: ASK THE PATIENT TO REPEAT AFTER GIVING 5 RANDOM DIGITS COMPREHENSION: ASK THE PATIENT TO PERFORM A MULTISTEP TASK .

6. DYSARTHRIA : caused by weakness, paralysis, or incoordination of the muscles used for speech. 2) APHASIA: language disorder affecting comprehension, production, or repetition of speech due to damage in areas of the brain responsible for language.

7. APHASIA Broca’s Aphasia (Non-fluent Aphasia): Speech is non fluent, slow and effortful not due to the involvement of muscles - BROCA’S AREA (FRONTAL LOBE) Wernicke’s Aphasia (Fluent Aphasia): fluent speech with normal grammar, rate but with incorrect/irrelevant words -words salad. Patient may be unaware - WERNICKE’S AREA IN TEMPORAL LOBE Conduction Aphasia: Fluent speech with normal grammar and syntax. Difficulty with repetition; patients may struggle to repeat phrases or sentences- ARCUATE FASCICULUS Global aphasia : significant impairment in both expression and comprehension of of speech

8. AGNOSIA ABNORMALITIES OF PERCEPTION DESPITE NORMAL PERCEPTIONS PROSPAGNOSIA: INABILITY TO RECOGNIZE FACES (FAMILY, FAMOUS PERSONS etc ) FINGER AGNOSIA: HEMI NEGLECT: NOT ABLE TO RECOGNIZE SENSORY STIMULUS IN ONE HALF OF THE BODY eg : INABILITY TO RECOGNISE THE DOCTOR FROM THE LEFT SIDE, INABILITY TO RECOGNISE RIGHT HAND TEMPORAL AND OCCIPITAL LOBE IS AFFECTED .

9. FRONTAL LOBE: BROCA’S APHASIA, JUDGEMENT, ABSTRACT THOUGHTS, PLANNING, BEHAVIOUR, ATTENTION PARIETAL LOBE: ACALCULIA, FINGER AGNOSIA, RIGHT LEFT DISORIENTATION, AGRAPHIA, SPATIAL AWARENESS TEMPORAL LOBE: EPISODIC MEMORY, AUDITORY PROCESSING, WERNICKE’S APHASIA, OCCIPITAL LOBE: VISUAL AGNOSIA, DEPTH PERCEPTION, MOTION PERCEPTION LIMBIC SYSTEM: EPISODIC MEMORY BASAL GANGLIA AND CEREBELLUM: EPISODIC MEMORY