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Orientation,
Memory
This patient has difficulty with orientation questions. The day of the week
is correct but he misses the month and date. He is oriented to place. Orientation
mistakes are not localizing but can be due to problems with memory, language,
judgement, attention or concentration. The patient has good recent memory
(declarative memory) as evidenced by the recall of three objects but has
difficulty with long term memory as evidenced by the difficulty recalling
the current and past presidents. |
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Attention-working
memory
The patient has difficulty with digit span backwards, spelling backwards
and giving the names of the months in reverse order. This indicates a problem
with working memory and maintaining attention, both of which are frontal
lobe functions. |
ii
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Judgement-abstract
reasoning
The
patient gives the correct answer for a house on fire and his answers for
similarities are also good. He has problems with proverb interpretation.
His answers are concrete and consist of rephrasing the proverb or giving
a simple consequence of the action in the proverb. Problems with judgement,
abstract reasoning, and executive function can be seen in patients with
frontal lobe dysfunction. |
ii
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Set
generation
Set generation tests word fluency and frontal lobe function. The patient
starts well but abruptly stops after only four words. Most individuals can
give more then 10 words in one minute. |
ii
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Receptive language
Patients with a receptive aphasia (Wernicke’s) cannot comprehend
language. Their speech output is fluent but is devoid of meaning and contains
nonsense syllables or words (neologisms). Their sentences are usually
lacking nouns and there are paraphasias (one word substituted for another).
The patient is usually unaware of their language deficit and prognosis
for recovery is poor.
This patient’s
speech is fluent and some of her sentences even make sense but she also
has nonsense sentences, made up of words and parts of words. She can’t
name objects (anomia). She doesn’t have a pure or complete receptive
aphasia but pure receptive aphasias are rare.
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Expressive
language
This patient with expressive aphasia has normal comprehension but her expression
of language is impaired. Her speech output is nonfluent and often limited
to just a few words or phases. Grammatical words such as prepositions are
left out and her speech is telegraphic. She has trouble saying “no
ifs , ands or buts”. Her ability to write is also effected.
Patients with expressive aphasia are aware of their language deficit and
are often frustrated by it. Recovery can occur but is often incomplete with
their speech consisting of short phrases or sentences containing mainly
nouns and verbs. |
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Praxis
The patient does well on most of the tests of praxis. At the very end when
he is asked to show how to cut with scissors he uses his fingers as the
blades of the scissors instead of acting like he is holding onto the handles
of the scissors and cutting. This can be an early finding of inferior parietal
lobe dysfunction. |
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Gnosis
With his right hand the patient has more difficulty identifying objects
then with his left hand. One must be careful in interpreting the results
of this test because of the patient’s motor deficits but there does
seem to be astereognosis on the right, which would indicate left parietal
lobe dysfunction. This is confirmed with graphesthesia where he definitely
has more problems identifying numbers written on the right hand then the
left (agraphesthesia of the right hand). |
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Dominant
parietal lobe function
This patient has right-left confusion and difficulty with simple arithmetic.
These are elements of the Gertsmann syndrome, which is seen in lesions of
the dominant parietal lobe. The full syndrome consists of right-left confusion,
finger agnosia, agraphia and acalculia. |
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Video
Courtesy of Alejandro Stern, Stern Foundation
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Non-dominant
parietal lobe function
The patient’s drawing of a clock demonstrates a problem with visuospatial
construction tasks, which reflects parietal lobe dysfunction. He doesn’t
neglect the left side of space but he lists the numbers of the clock in
two columns and then draws a line between the 8 and the 3 for 8:15. |
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Visual
recognition
Colors are correctly identified but the patient has difficulty correctly
identifying the face of a president that he is familiar with. Further testing
would be necessary to make sure this is prosopagnosia rather then a problem
with attention or long term memory. |
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