Disorders of Higher Cortical Function

Abstract

The chapter on higher cortical function starts with the major anatomic areas and divides the areas into three types: primary, secondary, and tertiary, based on their neuroanatomical interconnections and cellular structure. The asymmetry of brain and the importance of the left hemisphere in most individuals are discussed. Key tertiary areas that are important for complex perception, language, spatial skills, and executive functions such as problem solving and planning are discussed. The chapter explains the major types of aphasia, apraxia, amnesia, memory loss, and dysexecutive syndrome or ‘frontal lobe syndrome.’ The normal neurologic changes of aging and mild cognitive impairment follow. Finally, dementia and its types are covered with an emphasis on Alzheimer’s disease with attention to the pathophysiology, major clinical features, major laboratory findings, and principles of management and prognosis.

An 82-year-old woman who lives alone is brought home by the police after being found confused and unable to get back home. Her son is contacted, stays with her, and brings her to the neurologist for evaluation. The patient is very friendly and denies any concerns. Her son reports that she has been forgetful for the past year. In the past 6 months, he has been doing her monthly bills as he was concerned that she might forget to pay them. The neurologist performs a neurologic exam, which is normal with the exception of an MMSE of 17/30. CT of the head showed moderate cortical atrophy. She had normal laboratory workup. She was diagnosed with Alzheimer’s disease and started on daily donepezil.

Video Legend

This video shows a 35 year-old man s/p gunshot wound to left cerebral hemisphere

Segment 1: Language Exam

• Nonfluent or expressive aphasia

• Impaired auditory comprehension with multistep commands

• Telegraphic speech

• Intact repetition

• Circumlocution

Segment 2: Praxis Exam

• No limb apraxia