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Cognitive Assessment: Neurological Perspective
Jimmy Barus
Departemen Ilmu Penyakit Saraf
Fakultas Kedokteran Universitas Katolik Atmajaya/
Rumah SakitAtmajaya
Jakarta
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Memory
Attention
Orientation
Concentration
Language
Praxis
Recognition of stimuli (gnosis)
Social interaction
Construction
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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
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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
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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
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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
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(Jeffrey, 2003)
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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
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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
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Constructional apraxia: difficulties with
“constructions”
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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
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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
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Memori
Pilihan
kemauanEmosi
Input
sensorisMengatur
ProgramRencana
Aksi
Monitor
Dinilai dengan : Verbal fluency test
(Jeffrey, 2003)
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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.
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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
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scoscorree
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SKOR ISKEMIK HACHINSKY ( HIS )