Transcript Element of clinical interview

Geriatric Neropsychiatric
Assessment
Seyed Kazem Malakouti, MD
Geriatric Medicine Department
Iran University of Medical Sciences
Seyed Kazem Malakouti, MD
Element of clinical interview
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Gestation and birth history
Development of milestones
Handedness
Genetic history of the parents and sibling
School history: academic and disciplinary
History of violence or criminal behavior
history of head injury
Psychiatric history
Substance abuse history
Behavioral and cognitive baseline
Occupational history
Medical and surgical history
Medication regimen
Review of systems
Survey of vegetative functions
Assessment of activities of daily living
History of recent changes in behavior and cognition
Seyed Kazem Malakouti, MD
childhood
• ADHD:
it is not known whether residual ADHD extends into senescence
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Difficulty being organized
Low frustration tolerance
Impulsivity
Restlessness
Mood swings
• Gilles de la tourette’s syndrome
Seyed Kazem Malakouti, MD
Adolescence, risk-taking behavior
Adulthood
• Substance abuse
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Cocaine: precipitate stroke
LSD: visual hallucination
MPTP: parkinson’s
Alcohol: dementia, Wernicke-Korsakoff syndrome
• Reckless driving
• Head trauma
Seyed Kazem Malakouti, MD
Adulthood
Neurological problems that have particular relevance to the
neuropsychiatric evaluation
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Brain tumors
Huntington’s disease
Lupus Erythematosus
Multiple sclerosis
Nicotine dependence
Hypertension
Diabetes
hypercholesterolemia
Seyed Kazem Malakouti, MD
senescence
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Cohesive sense of integrity
Parkinson’s disease
Alzheimer’s
Frontotemporal dementia
Lewy body dementia
NPH
Subdural hematoma
Seyed Kazem Malakouti, MD
Cognitive domain assessment in geriatrics
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Attention
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Memory
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Learning
Recall
Recognition
Language
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Arousal
Concentration
Spontaneous output, fluency
Comprehension
Repetition
Naming
Visuospatial skills
Calculation
Praxis
Executive skills
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Drive
Programming
Response control
synthesis
Seyed Kazem Malakouti, MD
Social history
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Vocation & education
Habits & life style
Exercise
Sleep
Sexual activity
recreation
Seyed Kazem Malakouti, MD
sexual profile of the study subjects during the preceding month
Variables
Sexual fantasizing at least once
Males
109 (54.8%)
females
30 (15.7%)
Feeling desire to masturbate at least one time
64 (32.2%)
17 (8.9%)
Having desire to intercourse at least one time
160(80.4%)
48 (25.1%)
Having at least one sexual night dreams
101(50.8%)
25 (13.1%)
Masturbating for at least once
44 (22.1%)
14 (7.3%)
Feeling pleasure in most of sexual activities
118 (59.3%)
16 (8.4%)
Usually or mostly having Difficulty in achieving
orgasm
Experiencing at least one orgasm during sexual
intercourse
Difficulty or inability to communicate sexual desire
with the partner
Inability to experience partial of full erection
69 (34.7%)
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146 (73.4%)
33 (17.3%)
58 (29.1%)
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44 (22.1%)
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Not experiencing firm enough erection for penetration
43 (22.6%)
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Premature ejaculation
26 (13.1%)
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Retarded ejaculation
16 (8.0%)
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Seyed Kazem Malakouti, MD
18 (9.0%)
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No ejaculation
analysis of association of variables with sexual function
in male subjects
Variables
Sexual fantasizing at least
once
Feeling desire to masturbate
at least one time
Having desire to intercourse
at least one time
Having at least one sexual
night dreams
Masturbating for at least once
Feeling pleasure in most of
sexual activities
Experiencing at least one
orgasm during sexual
intercourse
Difficulty or inability to
communicate sexual desire
with the partner
Inability to experience partial
of full erection
Medical diseases
(Odds ratio)
Using medication
(Odds ratio)
GHQ
(Odds ratio)
1.29 (0.70-2.36)
1.34 (0.73-2.45)
1.90 (1.05-3.44)
1.71 (0.92-3.17)
1.82 (0.98-3.38)
0.87 (0.47-1.62)
1.07 (0.50-2.31)
1.10 (0.51-2.37)
2.19 (1.05-4.56)
0.93 (0.51-1.69)
0.97 (0.54-1.77)
1.03 (0.57-1.85)
1.47 (0.73-2.93)
1.42 (0.71-2.84)
0.92 (0.46-1.83)
1.18 (0.65-2.16)
1.23 (0.67-2.24)
2.14 (1.18-3.87)
1.51 (0.71-3.19)
1.35 (0.65-2.81)
1.47 (0.73-2.94)
0.88 (0.43-1.60)
0.80 (0.41-1.54)
0.40 (0.21-0.75)
1.05 (0.52-2.14)
0.95 (0.74-1.92)
2.06 (1.04-4.07)
Seyed Kazem Malakouti, MD
Variable
Male †
N (%)
Usually taken to fall sleep (minute)
5 to 20
117 (58.8)
21 to 30
26 (13.1)
31 to 60
15 (7.5)
60 +
41 (20.6)
Usually gotten up in the morning
1.30 to 3.59
20 (11.9)
4 to 5.59
78 (46.4)
6 to 7.59
58 (35.5)
8 to 8.59
5 (3.0)
9 to 10.59
7 (4.2)
Hours of actual sleep at night
59 (36.2)
2 to 5.30
102 (62.6)
6 to 9
2 (1.2)
9.30 +
Seyed Kazem Malakouti, MD
Female†
N (%)
p.value
105 (55.0)
23 (12.0)
31 (16.2)
32 (16.8)
0.06
0.01
14 (7.8)
61 (34.1)
80 (44.7)
16 (8.9)
8 (4.5)
72 (40.9)
102 (58.0)
2 (1.1)
NS
Variable
Male (N,%)
Legs twitching or jerking
No
Less than once a week
More than once a week
cannot get to sleep within 30 minute
No
Less than once a week
More than once a week
Wake up in the middle of the night or early
morning
No
Less than once a week
More than once a week
Have to get up to use the bathroom
No
Less than once a week
More than once a week
Cannot breathe comfortably
No
Less than once a week
More than once a week
Cough or snore loudly
No
Less than once a week
More than once a week
145 (79.7)
14 (7.7)
23 (12.6)
101 (53.4)
44 (23.3)
44 (23.3)
52 (29.4)
49 (22.6)
85 (48.0)
64 (35.6)
37 (20.6)
79 (43.9)
151 (80.3)
19 (10.1)
18 (9.6)
117 (66.6)
22 (11.6)MD
Seyed Kazem Malakouti,
51 (26.8)
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Female (n, %)†
P.value
152 (90.4)
9 (5.4)
7 (4.2)
0.01
59 (31.4)
49 (26.1)
80 (42.5)
31 (17.0)
47 (25.8)
104 (57.2)
42 (23.2)
50 (27.6)
89 (49.1)
151 (81.6)
14 (7.6)
19 (10.2)
114 (62.3)
27 (14.8)
41 (22.4)
0.001
0.01
0.07
NS
NS
Factors independently related to sleep quality by Pittsburg cutoff point of 5.0
*Confidence interval
Variable
P.value
Odds ratio
95% CI*
Sex (male=reference)
0.02
2.52
1.14-5.56
Marital
0.36
0.66
0.27-1.5
0.19
1.52
0.80-2.86
0.005
4.14
1.93-8.87
(married=reference)
Chronic disease
(no=reference)
GHQ (<10=reference)
Seyed Kazem Malakouti, MD
Geriatric Assessment Tools: Dementia and Delirium
• Clock Drawing Test
• Confusion Assessment Method
• Short Portable Mental Status Questionnaire
• Time and Change Test
Seyed Kazem Malakouti, MD
Cognitive assessment battery (CAB)
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Symbol Digit Modalities Test (speed & attention)
Text recall (learning and episodic memory)
Clox test (Visuospatial functions)
Token test and naming 30 items (language)
Stroop test (executive function)
Seyed Kazem Malakouti, MD
Arousal, alertness, level of consciousness:
the patient awareness of stimuli
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Fully alert
Lethargy
Obtundation
Stupor
Semi coma
Deep coma
Seyed Kazem Malakouti, MD
Glasgow coma scale
to monitor arousal state
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Eye opening (E)
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Spontaneous
To loud voice
To pain
Nil
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Best motor response (M)
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Obeys
Localizes
Withdraws (flexion)
Abnormal flexion posturing
Extension posturing
Nil
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Verbal response (V)
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Oriented
Confused, disoriented
Inappropriate words
Incomprehensible sounds
Nil
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Seyed Kazem Malakouti, MD
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Geriatric neuropsychiatric assessment in GM
1. cognition
1. MMSE
2. Mood
1. GDS
3. substance
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
• GDS-15, CUT OFF SCORE= 7/8
• GDS-11, CUT OFF SCORE=6
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
concentration
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Digit span: 5 digit
Reverse digit span: 3 digit
Serial 7s
Reverse sequence: week,
year…
• Continuous performance:
A’s letters, 30 second
• Reticular activating
system
• Originated from pons and
midbrain
• Thalamus
• Project to cortex and
subcortical areas
• Frontal, limbic system
Seyed Kazem Malakouti, MD
Memory
8 – 10 words
• Learning: word list test
(immediate, working memory
• Retaining: (recognition) with
clue
• Recall: (retrieve) w/o clue
• Verbal memory: word list,
left temporal
• Visuospatial memory: right
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Limbic system
Medial temporal lobe
Fornix
Dorsomedial thalamic
nuclei
• Mammillary body
temporal, hidden object in the
room.
Seyed Kazem Malakouti, MD
Language, aphasia
Aphasia
type
Writing
Repetition
Fluency
Comprehe
nsion
Naming
Reading
Cerebral
lesion
Receptive
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Conduction
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III
Expressive
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II
Global
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I,II,III
Precentral
Transcortic
al sensory
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A
Anomic
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Transcortic
al motor
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C
Isolation
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A,B,C
Seyed Kazem Malakouti, MD
Anatomic regions of aphasia
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Visuospatial impairment
• Getting lost in familiar places
• Difficulty estimating distances
• Difficulty orienting objects to complete a
task
• Drawing a picture
Seyed Kazem Malakouti, MD
visuospatial drawing
Seyed Kazem Malakouti, MD
Executive function
• Drive
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Spontaneous
Motivation
Sustained performance
• Programming
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Recognizing pattern
Time sequence
Rhythmic pattern
• Response control
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Divided attention
Inhibition of incorrect response
Planning
Mental flexibility: changing strategy
Use feedback
Resist stimulus bound behavior
• Synthesis
» Abstraction: similarities, proverb interpretation
» Monitoring cognitive performance
» anticipation
Seyed Kazem Malakouti, MD
Programming exam
• Alternative program
• Hand sequence: slap,
fist, cut
Seyed Kazem Malakouti, MD
Response control
• Divided attention: 1-A, 2-B, 3-C, …
• Verbal fluency: 12 animal or 10 F words in 1 minute initiation, strategy,
perseveration
• Reciprocal programs (go/no-go). Changing mind, stimulus
inhibition
• Tap1-tap2, tap 2-tap1
• Tap 1 –tap 2, tap2-tap 0
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Multiple loops
Clock drawing
Stimulus boundedness: put the clock hands. 11:10, brown word.
Imitation behavior
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
synthesis
• Similarities
• Proverbs
• monitoring
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Assessment of activities of daily
living
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Bathing
Toileting
Eating
Transporting
Dressing
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Cooking
Paying bills
Household chores
Shopping
Driving
Telephone calling
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Recent cognitive changes
Major neuropsychiatric syndroms affects cognitive
conditions
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Age-related problem
Prefrontal system dysfunction
Generalized cortical systems disorders
Focal cortical dementia syndromes
Subcortical systems disorders
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
cognition
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Validation of a Mini-Mental State Examination (MMSE) for the Persian
population: a pilot study.
Ansari NN, Naghdi S, Hasson S, Valizadeh L, Jalaie S.
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Faculty of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave.,
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Pitch-e-shemiran, Tehran, Iran. [email protected]
Abstract
The objective of the study was to develop and validate a translated and culturally adapted MiniMental State Examination (MMSE) for the Persian-speaking population. The MMSE was
translated into Persian. Two groups of neurologically intact subjects (n = 100) and subjects with
Alzheimer's disease (n = 13) were studied. The difference between groups on the mean total
scores of the Persian MMSE was statistically significant (control = 28.62 +/- 2.09; subjects with
Alzheimer's disease = 11.77 +/- 5.66; p < .001). The cutoff score of 23 was the best cutoff
score for our subjects with a sensitivity and specificity of 98% and 100%, respectively. There was
a significant correlation between the Persian MMSE score and the level of education (r = .46) and
with age (r = -.77). There was no significant correlation between the Persian MMSE and gender.
The Persian MMSE was found to be valid for discrimination of cognitive impairment in the
Persian-speaking community.
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
‫ارزیابی مراحل عملکردی ‪Functional Assessment Staging‬‬
‫اگر در هر قسمت فکر می کنید که علت ایجاد مشکل برای بیمار‪ ،‬موضوع دیگری به جز بیماری فراموش است (مانند فلح‪ ،‬ارتریت و ‪ ).....‬لطفا گزنیه "خیر" را عالمت بزنید‬
‫و آن عامل را کنار قسمت مربوطه بنویسید‪.‬‬
‫کد‬
‫نرمال ‪1‬‬
‫‪2 Pre-MCI‬‬
‫‪MMSE=28-29‬‬
‫‪3 MCI‬‬
‫‪MMSE=24-28‬‬
‫‪4 MILD‬‬
‫‪DEMENTIA‬‬
‫‪MMSE=19-20‬‬
‫‪5‬‬
‫‪6a‬‬
‫‪6b‬‬
‫‪6c‬‬
‫‪6d‬‬
‫بله‬
‫عنوان قسمت‬
‫چه از نظر بیمار و چه از نظر اعضای خانواده وی که در جریان زندگی‬
‫بیمار قرار دارند‪ ،‬او هیچ مشکلی ندارد‬
‫بیمار از فراموش کردن محل اشیاء شکایت می کند و در انجام وظایف‬
‫شغلی خود مشکلی دارد‪-‬احساس ذهنی فراموشی در بیمار وجود دارد‬
‫اختالل در عملکرد شغلی برای همکاران بیمار مشخص است و در رفتن‬
‫به مکان های جدید مشکل دارد‪ .‬ظرفیت های سازماندهی کارها تقلیل پیدا‬
‫کرده‪.‬‬
‫توانایی بیمار در انجام امور پیچیده کاهش یافته است (مانند رسیدگی به‬
‫امور مالی‪ ،‬به طور صیحیح مشکل دارد‪ ،‬حاضر کردن غذا‪ ،‬خرید کردن‬
‫از مغازه)‬
‫بیمار برای انتهاب لباس متناسب با فصل و مناسبتها نیاز به راهنمایی‬
‫دارد‬
‫در پوشید لباس و کفش به طور صحیح و یا بستن دکمه‪ ،‬بند کفش و کمر‬
‫بند به طور حیحی مشکل دارد‬
‫نمی تواند به درستی حمام کند‪ ،‬برای حمام کردن مقاومت می کند و یا از‬
‫حمام رفتن می ترسد‬
‫نمی تواند از توالیت به درستی استفاده کند‪ ،‬نمی تواند خود را به درمستی‬
‫تمیز کند یا توانلت را تمیز نگه دارد‬
‫بیمار اغلب در طی هفته های گذشته بی اختیاری ادار داشته است‬
‫‪6e‬‬
‫اغلب در طی هفته های گذشته بی اختیاری در دفع داشته است‬
‫‪7a‬‬
‫توانایی بیمار در صحبت کردن محدود شده است (یک تا شش کلمه در‬
‫روز)‬
‫میزان لغات قابل فهم بیمار کاهش یافته یا شدیدا کم شدشده است‪ .‬ممکن‬
‫است کلماتی در دائما تکارکند‬
‫بیمار نمی تواند بدون کمک افراد راه برود‬
‫‪7d‬‬
‫نمی تواند بصورت مستقل بنشیند‬
‫‪7b‬‬
‫‪7c‬‬
‫‪Seyed Kazem Malakouti, MD‬‬
‫از چند وقت قبل این مشکل‬
‫وجود داشته است؟‬
‫خیر‬
‫عالیم‬
‫بیمار عملکرد طبیعی دارد‪ ،‬فراموشی ندارد‪ ،‬از نظر روانی طبیعی‬
‫است‪.‬‬
‫‪Stage 1:‬‬
‫‪No Cognitive Decline‬‬
‫فقدان دمانس‬
‫فراموشی طبیعی قابل مشاهده است‪ ،‬مانند اسامی‪ ،‬جابچا گذاشتن‬
‫اشیاء‪ ،‬این عالیم برای اعضاء خانواده و پزشک ملموس نیست‬
‫‪Stage 2:‬‬
‫‪= PRE MCI‬‬
‫فقدان دمانس‬
‫اشکال در تمرکز فکر‪ ،‬کاهش عملکرد؛ احتمال گم کردن مسیر‪ ،‬اشکال‬
‫در پیدا کردن لغات صیحیح‪ ،‬عضو خانواده متوجه اختالل می شود‪ ،‬این‬
‫مرحله ‪ 7‬سال قبل از شروع دمانس ظاهر می شود‪.‬‬
‫‪Stage 3:‬‬
‫‪MCI‬‬
‫فقدان دمانس‬
‫اشکال در تمرکز فکر‪ ،‬کاهش حافظه اخیر‪ ،‬اختالل در مدیریت مالی و‬
‫انجام جابجا شدن در شهر به تنهایی در شهر‪ ،‬اختالل در انجام کارهای‬
‫پیجیده و انکار این اختالل‪ ،‬انزوا از دوست و خانواده‪ ،‬کشف اختالل‬
‫واضح شناختی توسط پزشک‪ ،‬مدت متوسط این مرحله ‪ 2‬سال‪.‬‬
‫‪Stage 4:‬‬
‫‪= MILD DEMENTIA‬‬
‫اختالل بارز حافظه؛ نیاز به کمک در کارهای روزمره مانند حمام‬
‫کردن‪ ،‬لباس پوشیدن)‪ ،‬اختالل در گفتن شماره تلفن و ادرس‪ ،‬اختالل‬
‫در شناسایی روز و ساعت‪ .‬مدت زمان ‪ 1.5‬ساعت‬
‫کمک زیادی برای انجام کارهای روزمره خود دارد‪ ،‬نام اعضاء خانواده‬
‫خود را از دست میدهد‪ ،‬اختالل در شمردن اعداد از ‪ 10‬به پایین‪،‬‬
‫اختالل کنترل ادرار یا مدفوع‪ ،‬بروز هذیان‪ ،‬اختالل شخصیت‪ ،‬رفتارهای‬
‫وسواسی‪ ،‬اضطراب و بیقراری‪ .‬متوسط دوره ‪ 2.5‬سال‪.‬‬
‫تشخیص‬
‫‪Stage‬‬
‫مرحله اول دمانس‬
‫‪Stage 5:‬‬
‫‪MILD‬مرحله دمانس خفیف‬
‫‪Mild to moderate dementia‬‬
‫‪Stage 6:‬‬
‫‪moderate dementia‬‬
‫مرحله متوسط دمانس‬
‫قادر به تکلم نیست‪ ،‬قادر با برقراری ارتباط نیست‪ ،‬در بسیاری از‬
‫‪Stage 7:‬‬
‫کارهای روزمره نیاز به کمک دارد‪ ،‬اختالل در حرکت‪ ،‬مهارت هایی‬
‫‪severe dementia‬‬
‫‪Seyed Kazem Malakouti, MD‬‬
‫مانند راه رفتن‪ .‬متوسط دوره ‪ 2.5‬سال‪.‬‬
‫مرحله نهایی‬
Prefrontal system dysfunction
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Dorsal convexity
dysexecutive sydrome
Cognitive Flexibility
Ordering recent events
Planning ahead
Regulating actions based
on environmental stimuli
Learning from experience
• Concrete
• Perseverative
• Impairment in reasoning
and flexibility
• Pay bills on time
• Organize daily activities
• Keep a tidy house
• Cook balance meals
Seyed Kazem Malakouti, MD
Orbitofrontal disinhibition
syndrome, Mania, witzelsucht
• Connection with limbic
• Behavioral response to
various environmental
stimuli and anticipate the
consequences
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Poor impulse control
Aggressive outburst
Jocularity
Lack interpersonal
sensitivity
Seyed Kazem Malakouti, MD
Mesial frontal apathetic syndrome
• Balance between the
cingulum and
supplementary motor
area
• Dysemotional sydrome
ranging from apathy to
akinetic mutism
• Neurovegetative of
depression
• Exist ideas for activity but
no motivation
• Perceived as a willful
indifference
Seyed Kazem Malakouti, MD
Generalized cortical systems
disorders
• Alzheimer’s disease
• Frontotemporal dementia
• Lewy body dementia
Seyed Kazem Malakouti, MD
focal cortical dementia syndromes
• Progressive frontal lobe syndromes
• Progressive aphasia
• motor aphasia, naming, mixed
• Progressive perceptual motor syndromes
• progressive bi-temporal syndrome
Seyed Kazem Malakouti, MD
Fluent aphasia
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Wernike’s aphasia
Nonsensible speech
Not able to comprehend others speech
Damage to unimodal association cortex in
area 22
• Superior temporal gyrus
Seyed Kazem Malakouti, MD
Non-fluent aphasia
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Broca’s aphasia
Agrammatic
Telegraphic speech
Difficulty using the words: but, if, or, to ,
from
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Progressive perceptual-motor
syndromes
Visual syndromes
• Occipitoparietal network
• Occipitotemporal network
• Asimultagnosia
• Able to describe the details
• unable to integrate entirely
• Visual disorientation
• Balint’s syndrome
Motor syndromes
First one(frontoparietal)
• Hemispasticity
• Hemiparesis
• Hemisensoryimpairment
» Astereognosis
» agraphesthesia,
myoclonus
• Second one
• Asimultagnosia
• Optic apraxia
• Optic ataxia
• Visual agnosia (bilateral
occipitotemporal)
• Inability to name the objects
• prosopagnosia
• Mixed apraxia
• Limb apraxia: combing,
brushing
• Gestural apraxia: imitating
• Constructional apraxia:
drawing
• Writing apraxia
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Progressive bitemporal syndromes
• Progressive amnesia
• Progressive prosopagnosia
• Kluver-Bucy syndrome
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Bilateral amygdala destruction
Hyperorality
Emotional placidity
Hypersexuality
Compulsive exploration of the environment
Psychic blindness
Seyed Kazem Malakouti, MD
Subcortical system disorders
5 neural loop (Alexander, Crutcher-1990
• Striatum
• Supplementary motor
area
• Globus pallidus
• Frontal eye fields
• Dorsomedial thalamus
• Dorsolateral prefrontal
(cognition)
• Orbitofrontal (social
comportment)
• Anterior cingulate
(motivation)
Seyed Kazem Malakouti, MD
Movement manifestation of BG
dysfunction
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Tremor
Agitation
Akatisia
Shuffling gait
Bland expression
Striatal hand: ulnar deviation, flexion of fingers at the metacarpal
phalangeal joints
Pill rolling tremor
Loss of agility
Involuntary movements
chorea
Seyed Kazem Malakouti, MD
Localizing neuropsychiatric findings
biparietal
History
Mental status
Sensorimotor
•Spatial disorientation
•Asimultagnosia
•Inferior
quadrantanopia
•Ocular apraxia
•Optic ataxia
Seyed Kazem Malakouti, MD
Cognitive manifestation of BG dysfunction
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Cognitive problem: mental torpor,
cognitive dilapidation, apathy,
depression.
Learning, speech and language,
praxis, calculation are intact.
Retrieved material impaired.
Required number of prompt
indicate the degree of
impairement.
Impersistence and slowed
completion of task
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Huntington’s disease
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Parkinson’s disease
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Lacunaire syndrome
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Tumors
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Progressive supranuclear palsy
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Multisystem atrophy
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Wilson’s disease
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Corticobasal degeneration
Seyed Kazem Malakouti, MD
Localizing neuropsychiatric findings
frontal
History
Disorganization
Disinhibition
apathy
Mental status
High-level attention
deficit
Luria motor sequences
deficit
Go/no-go task deficit
Decrease in verbal
fluency
Perseveration
Losses of set
Confabulation
Witzelsucht
dilapidation
Seyed Kazem Malakouti, MD
Sensorimotor
Gait apraxia
Mitgehen
Ipsilateral gaze
preference
Primitive reflexes
Localizing neuropsychiatric findings
BG
History
Mental status
•Motor impairment
•Social withdrawal
•Cognitive
impairement
•Dilapidation
•Mental torpor
•Retrieval deficit
Seyed Kazem Malakouti, MD
sensorimotor
•Hypokinesia
•Masked facies
•Stooped posture
•Festinating gait
•abnormal
movement
•Muscular rigidity
•Cogwheeling
•Gegenhalten/negativ
ism
•Downward gaze
palsy
Localizing neuropsychiatric findings
parietal
History
Mental status
Sensorimotor
•Spatial disorientation
•Inconvenient
view test
•Butters test
•Benton test
(spatial memory)
•Localizing things
(where)
•Dyslexia
•Visual & touching
disharmony
•hemiagnosia
•Anosognosia (rt)
•Autotopagnosia (lt)
•Simultaneous
extinction (rt)
•Asteregnosia
•Rt & lt disorientation
(lt)
•Acalculia (lt)
•Agraphestesia
•Agraphia (lt)
•Apraxia, dressing
Seyed Kazem Malakouti, MD
•Constructional
•Inferior
quadrantanopia
•Ocular apraxia
•Optic ataxia
•Sensory deficit
(opposite)
Localizing neuropsychiatric findings
right hemisphere
History
Mental status
•Confusion state
•Delusions
•Spatial
disorientation
•Neglect
•Denial of deficit
•Dressing
difficulties
•Left-sided motor
impairment
•Dysprosodia
•Visuoconstructive deficit
•Spatial analysis deficit
•Left hemineglect
•Visual memory deficit
•Dressing apraxia
Seyed Kazem Malakouti, MD
sensorimotor
•Left hypertonus
•Left babinsky
sign
•Left
astereognosis
•Left
dysgraphesthesia
•Double
simultaneous
extinction
•Posturing of left
hand/arm with
tandem gait
•Left pronator drift
•left
quadrantanopia
Localizing neuropsychiatric findings
left hemisphere
History
Mental status
sensorimotor
•Right-sided motor
impairment
•Language
impairment
•Math impairment
•Ideomotor apraxia
•Dysphasia
•Dyslexia
•Dyscalculia
•Dysgraphia
•Right/left disorientation
•Finger agnosia
•Right
hypertonus
•Right babinski
sign
•Right
asterognosis
•Right
dysgraphestesia
•Posturing of
right hand/arm
with tandem gait
•Right pronator
drift
•Right
quadrantanopia
Seyed Kazem Malakouti, MD
Localizing neuropsychiatric findings
bitemporal
History
Mental status
Sensorimotor
•Placidity
•Hyperorality
•Hypersexuality
•Amnesia
•Agnosia
•Visual: right
•Auditory: left
•Anomia
•Prosopagnosia
•Superior
quadrantanopia
Seyed Kazem Malakouti, MD