HIGHER CORTICAL FUNCTION

NEUROLOGY DEPARTMENT
MUHAMMAD HOESIN GENERAL HOSPITAL
2015

Higher Cortical Functions

Mental Functions
Clinical Neuropsychology
Behavioural Neurology

BRAIN

Cerebral Cortex Components

Initiation of movement (M otoric)
Sensation from the body and the special
sensory organs (Sensoric)
The cerebral cortex is also the substrate for
functions that convey
comprehension,cognition, and
communication

Cerebral Components of
Higher Cortical Functions

Cortex Cerebri (Cytoarchitectonic).

Limbic System.
Reticular Formation.
Diencephalon.
Associated Projection.
Non-Specific A fferent System (collateral
network to cortex).

Cytoarchitectonic
Area 4

Motor cortex

Area 6

Supplementary motor
cortex

Area 22

Wernickes area

Area 44, 45

Brocas area

CEREBRAL CORTEX

Lateral organization
(Left & Right brain)
Sperry (1970)

Left Hemisphere Lingual Hemisphere

Right Hemisphere Non Lingual Hemisphere

Non-Dominan Hemisphere Syndrome

o
o
o
o
o

Left Hemisphere
Aphasia.
Apraxia.
Alexia.
Agraphia.
Gerstmann Syndrome.
o Left-right
Disorganization.
o Acalculia.
o Finger Agnosia.
o Agraphia.

Right Hemisphere
o Attention & Emotion
disturbances.
o Visuospatial Disturbances :
o Construction A praxia.
o Dressing A praxia.
o Prosopagnosia A musia.

Frontal Lobe Syndrome

Caused by brain tumor, head trauma, etc.

Bilateral lesions.
Sign and symptoms :
Behavioral changes (labile, irritable, apathetic,
inattentive, akinesia syndrome).
Impaired intellectual and cognitive function.
Alteration in personality and mood.

Parietal Lobe Syndrome

Apraxia.
Agnosia.
Disorientation.
Impaires Body Image.
Hemiparesis, Hemihipesthesia.
Hemianopsia.

HCF
The High Cortical Functions are
1.Memory
2.Orientation
Regular Assesment
3.Concentration
4.Language
5.Performance of learned skilled movements
(eq. Apraxia)
6.Recognition of Stimuli (eq. Agnosia)

MENTAL STATUS EXAMINATION

MMSE RESULT

MEMORY
Memory is the ability to revive past thoughts
and sensory experiences.
RegistrationThe ability to perceive,
recognise, and establish information in
CNS
RetentionThe ability to retain registered
information
Recall the ability to retrieve stored
information at will

Tests of Memory
Short-term Memory Recall of material
within a period of up to 30 secs
Long-Term Memory
Recent Memory :events occuring during
past few hours to the past few months
Remote Memory : events occuring in
past years

ORIENTATION
Orientation in Time
Orientation in Place
Orientation in Person

ATENTION (CONCENTRATION)
Attention is a multifaceted mental function,
but in general, it denotes the capacity of an
individual to focus the mind (pay attention
to) some aspect of the environment or the
contents of the mind itself.

Tests of Attention
History and Conversation
Substraction
Reversing Components

LANGUAGE
Spontaneous Verbal
Comprehension
Naming
Repetition
Reading Ability
Writing Ability

Alexia
Inability to read.
Alexia with agraphia : impairment of reading
and writing, caused by lesions at the angular
gyrus.
Alexia without agraphia : unable to read,
although writing is not impaired, caused by
lesions at left visual cortex and the splenium
of corpus callosum.

Aphasia

Refers to loss or impairment of language

function as a result of brain damage.

Type of aphasia result from lesions in

specific regions of the cerebral hemisphere.

Types of A phasia

Type

Fluency Comprehension Naming Repetition

Brocas
Wernickes

+
-

+
-

Global
Conduction
Motor Transcortical

+
-

+
+

+
-

Sensory Transcortical

Mixed Transcortical

Anomic

Apraxia
The inability to carry out motor acts correctly
despite intact motor and sensory pathways,
intact comprehension, and full cooperation.
Caused by cortical association disturbances.
Ideational apraxia, ideomotor apraxia, kinetic
apraxia, dressing apraxia, constructional
apraxia.

CONSTRUCTIONAL APHASIA
In the testing
situation the patient
is asked to copy a
drawing on paper or
an arrangement of
blocks, or other
physical objects.
The Rey Osterrieyh
Complex Figure

INTERLOCKING TEST FINGER

The IFT is the 1st bedside/office test of the
parietal lobe to be
described in many
decades. It probably
entails limb praxis,
visual-spatial, and
visuoconstructional
skills, and poor
performace is highly
correlated with parietal
lobe pathology.

Agnosia

Difficulty in identification or recognition.

Caused by disturbances in the association functions of the
cerbral cortex.
Astereognosis : failure of tactile recognition.
Visual agnosia.
Prosopagnosia : inability to recognize familiar faces.
Unilateral neglect : fail to respond to stimuli in one half of
space.
Anosognosia : lack of awareness of disease or denial of
illness.

Unilateral Neglect
Unilateral (left-sided) neglect in a patient with
a right hemispheric lesion.

You know about

HCF

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