Descriptive Psychopathology: The Signs and Symptoms of ...

323 Chapter 13: Testing and psychopathology of cognitive dysfunctiondecline as the difficulty of the task increases. Recall of similarities will be belowexpectations, but may improve with cueing or by recognition of the just workedon similarities when they are embedded in lists of novel choices. The patient mayunderstand the verbal absurdity of the “man with the flu” but may give a concreteanswer to the train statement.Fluency of ideas and problem solving abilities deteriorate in frontal–temporaldementia. Idea fluency is assessed with the animal naming test. The patient isasked to name as many animals as he can. The time cut-off is one minute. Normalpersons with at least a high school education can name 15 or more animals. Tenor more is acceptable for persons over 80years of age. Perseverative animal namesare counted only once, thus dog, poodle, retriever gains only one point, as doeswhite horse, black horse, and pinto. The most efficient strategy is to begin withthe first animal that comes to mind and staying with that category of animal untilrecall slows and then quickly switching to another category until that too seemsexhausted, then switching again, and so on. Executive function and cognitiveflexibility must be adequate to perform the task well.Problem solving is another assessment of thinking impacted by frontal circuitrydisease. It is assessed by asking the patient to solve the following:“If I had three apples and you had four more than I, how many would you have?”“If you had 18 books and wanted to place them on two different book shelves so that oneshelf had twice as many books as the other, how many would be on each shelf?”Patients with a frontal–temporal dementia perform adequately on perceptual–motor tasks. Early on in the course of illness, memory disturbances will respondto cueing and recognition. Praxis is normal. An example follows. 27Patient 13.4A 70-year-old man experienced decreased functioning over a two-year period.He was becoming more forgetful, had trouble keeping the family accounts,and was distressed that he could no longer remember the names of closefriends. His wife observed him urinating in the sink and when challenged, hesaid that it was to “save water”. He purchased several hundred nut trees withoutgood reason, poured several boxes of detergent into the washing machine at onetime, wandered in his conversation and became irritable and stamped his footin anger when challenged. Irritability alternated with inappropriate jocularity.Unlike his past behavior, he was openly amorous toward his wife. He hadparaphasic speech, echophenomena, and motor aprosodia. He became gluttonous,incontinent of urine and feces and unable to care for himself. Hisvisual and verbal memory, however, were initially normal. Reading ability waspreserved. Brain imaging revealed frontal atrophy.