CORTICAL FUNCTION

Anatomy and physiology

Cortical function:
 Three major operation of neurons of the
CNS:
 Reception and registration of sensory
stimuli from outside and from within.
 Planning and execution of complex motor
act.
 Intermediary processing.
.(thought,language,memory,self
awareness,mood and affect)
Cerebral hemisphere : right and left
connecting by corpus calosum
Cerebral hemisphere are divided
 Primary sensory cortex.
 Primary motor cortex.
 Association cortex.
 Limbic-paralimbic cortex
Cortical function : specific location
 Primary receptive area
 Secondary receptive area
 Association area
NEUROBEHAVIOR:
 How environmental stimuli are processed within the
central nervous system (CNS) to effect behavioral
and emotional responses.
 Processing of stimuli are recognition, interpretation,
storage and retrieval of information to which meaning
is attributed from the past and present experience.
 Task performance in daily activities is a result of
behavioral responses.
 The mechanism of nervous system processing and
neurobehavior is thus a complex interaction of
processing and responses
NEURO-BEHAVIOR
 Mempelajari hubungan antara perilaku
dengan fungsi otak.

 Behavior/perilaku:
 Hasil aksi dan reaksi psikomotor yang secara
objektif dapat diamati dan diinterpretasikan dan
akan mempengaruhi lingkungan subyek tsb
 Mencakup berbagai fungsi,aktifitas
motorik,komunikasi,aksi/tindakan sosial dan
ekspresi afektif.
 Perilaku dapat dibedakan atas:
 Goal oriented behavior:
 Komponen sensorik ,psikomotor,emosi dan kognitif
bekerja harmonis sesuai dengan keinginan dan tujuan
individunya.
 Specific oriented behavior:
 Perilaku yang muncul pada situasi tertentu sebagai suatu
reaksi terhadap stimulus tertentu misalnya
impulsif,kecewa,kekerasan.
 Perilaku ini patologis,mencerminkan kegagalan
kognitif,kepribadian yang abnormal atau disfungsi
neurobiologik.
Behavior Neurology:
 Pengaruh penyakit otak pada perilaku
manusia dan fungsi kortikal luhurnya.
 Perilaku termasuk :
 Perilaku spesifik seperti
memori,komunikasi dan visuospatial.
 Perilaku kompleks:Kualitas
intelegensia,emosi,suasana hati dan
kepribadian.
BEHAVIOR NEUROLOGY ;
 Bertujuanuntuk membedakan perilaku
normal dan abnormal dalam kaitan
dengan fungsi otak yang normal atau
abnormal.
Neuropsikologi:
 Bagian dari psikologi yang berkaitan
dengan pemeriksaan fungsi otak
dengan menggunakan tes psikologi
yang baku.
 Neuropsikologi membantu untuk
mendapatkan data kuantitatif
pemeriksaan neurobehavior yang
penting dalam penatalaksanaan pasien.
Neuropsikiatri:
 Mempelajari abnormalitas fisik atau
organik yang mendasari gejala psikiatri
dimana tidak dapat dibuktikan adanya
lesi primer diotak
HIGHER COGNITIVE
FUNCTION
HIGHER COGNITIVE
FUNCTION:
 Manipulation of well learned material,
abstract thinking, arithmetic
computations is the highest level of
human intellectual functioning.
 Represent the most advanced stages of
intellectual development, often highly
susceptible to neurological diseases
Higher Cognitive Function
 Coordination of external and internal factor
in human being
 Study of the relation between brain and
behavior
 Basic Processes :
1. Attention and consentration
2. Language
3. Memory
4. Visual-spatial
5. Executive
6. Emotion
7. Praxis
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 Memory
(Amnesia Syndrome)
1. Retrograde amnesia
 Impairment of memory for events that
antedate illness or injury
2. Anterograde amnesia
 Inability to learn new verbal or non-verbal
information from onset of illness or injury
Disorders of Memory Retrieval
 Senescence – AAMI (Age Associated
Memory Impairment) – Rapid retrieval
of stored memory become defective
 Depression – disorder in motivation and
concentration
 Subcortical dementia – Slowed (but
correct) response rate to questions of
memory function
Disorder of Language - Dysphasia

Language  function of dominant

hemisphere
 Emotional - Instinctive expression of
feelings
 Symbolic or proportional 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. Broca’s Area
 Executive or motor
for production of
language
 Broca’s dysphasia
 Motor dysphasia
 Nonfluent / hesitant
speech
 Telegraphic speech
 Comprehension –
good
 Handwriting - pure
Wernick’s Area – Receptive Area
 Wernick’s 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. Space occupying lesion
3. Traumatic
4. Infection
5. Degenerative disorders
Mental State Examination
 MiniMental State Examination.
Score 0-30
 Orientation (time.place) 0-10
Memory registration 0-3
 Attention and Concentration 0-5
 Memory Recall 0-3
 Language 0-8
 Visual-patial 0-1
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 subtractions. 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