Cognitive Assessment: Neurological Perspective

Jimmy Barus

Departemen Ilmu Penyakit Saraf

Fakultas Kedokteran Universitas Katolik Atmajaya/

Rumah SakitAtmajaya

Jakarta

Memory

Attention

Orientation

Concentration

Language

Praxis

Recognition of stimuli (gnosis)

Social interaction

Construction

The capacity of an individual to focus the mind on

(pay attention to) some aspect of the environment

or the contents of the mind itself (Cutting, 1992)

Examination:

History and conversation

Subtraction: MMSE 100-7 …

Reversing components: spell backward, mentioning the

names of the months backward, counting backward from

20 - 0

Short-term memory: the recall of material within

a period of up to 30 seconds after presentation

Long term memory

Recent memory: events occurring during the past few

hours to the past few months

Remote memory: events occurring in past years

Influenced by: physical lesions, intoxication,

emotional arousal, psychomotor retardation,

thought disorder and motivation

History and conversation

Short-term (immediate) memory test Digit span

Recent memory test Three words recall

Remote memory test

The date of birth

The names and dates of birth of the patient’s children

Capital cities

The name of the current President

Orientation

Awareness of one's relationships and surroundings in time, place and person

Orientation in time

year, month, day of the week, date, and time of day

Orientation in place

MMSE: room, hospital, town, province, country

Orientation in person

Including the capacity to recognise faces (prosopagnosia: agnosia for faces)

Memory

(Jeffrey, 2003)

Repetition

intact

Repetition

impaired

Repetition

intact

Repetition

impaired

Repetition

intact

Repetition

impaired

Repetition

intact

Repetition

impaired

Conduction

Transcortical

sensory

Wernicke’s

Transcortical

motoric

Broca’s

Isolation

Global

AnomicComprehension

intact

Comprehension

impaired

Comprehension

intact

Comprehension

impaired

Fluent

Non

fluent

Aphasia

Ideomotor apraxia:the inability to perform

common actions

shaking hands on meeting friends, etc

Results due to the disconnection from language area

to motor area

Dressing apraxia: difficulty in orienting articles of

clothing with reference to the body

seen in dementia and right parietal lobe lesions,

common in confusional states

Constructional apraxia: difficulties with

“constructions”

Recognition of stimuli and AGNOSIA

Gnosis (Gr. gnosis “knowledge”) higher synthesis of

sensory impulses resulting in the recognition of stimuli

Visual object agnosia: inability to recognise a familiar

object which can be seen

left occipital lobe lesions

Agnosia for faces (prosopagnosia)

bilateral lesions of the mesial cortex of occipital and temporal lobes

Tactile agnosia: inability to recognise objects by touch

unilateral or bilateral lesions of the postcentral gyrus

Recognition of stimuli and AGNOSIA

Auditory agnosia: inability to recognise non-verbal acoustic stimuli unilateral or bilateral

temporal lesions

Spatial agnosias include disorders of spatial perception and loss of topographical memory bilateral cortical

lesions

Memori

Pilihan

kemauanEmosi

Input

sensorisMengatur

ProgramRencana

Aksi

Monitor

Dinilai dengan : Verbal fluency test

(Jeffrey, 2003)

A standardised, widely accepted screening test Examines Orientation

Registration

Recall

Attention/concentration

Language

Constructional abilities.

Strength Brief

Weakness: Not providing a comprehensive assessment

Screening, may indicate a need for more extensive testing.

3 –7

7 –4 – 9

8 –5 –2 – 7

2 –9 –6 –8 – 3

5 –7 –2 –9 –4 – 6

8 –1 –5 –9 –3 –6 – 2

3–9–8–2–5–1–4–2

7–2–8–5–4–6–7–9–3

scoscorree

SKOR ISKEMIK HACHINSKY ( HIS )