Descriptive Psychopathology: The Signs and Symptoms of ...

325 Chapter 13: Testing and psychopathology of cognitive dysfunctionRight/left orientation: In addition to accurately perceiving the left and rightsides of the body, the person without brain disease can coordinate motor performancewith the perception. This is tested by asking the patient to placehis hand on a body part that requires crossing the midline with such questionsas, “Place your left hand on your right ear ... place your right hand on yourleft elbow.” Persons with dominant parietal lobe disease have difficulty withthis task. 30Praxis: Praxis is tested by asking the patient to do simple motor tasks (seeChapter 7). Patients with dominant frontal–parietal disease will have difficultieswith these efforts.Copying geometric shapes (see above) is used to assess visual–motor coordination.Verbal and visual memory is assessed by asking the patient to recall someaspect of a previously performed task, such as recalling the geometric shapespreviously copied and the objects considered in similarities. Recalling the types oftests in the evaluation assesses memory for events, or episodic memory.Assessing for amnestic syndromesAmnestic syndromes are defined as a memory disturbance associated with substantialdecline from previous social or occupational functioning. New learningor recall of previously learned information is impaired. The disturbance does notoccur exclusively during a delirium or a dementia, and persists beyond the usualduration of states of intoxication or withdrawal.Memory, however, is not a single process easily assessed by one screening test.The MMSE does not test visual memory. Its three-word immediate and fiveminuterecall item is a perfunctory assessment of verbal new learning and recall.It is also insensitive to the different patterns of impairment seen in the differentdementias. Patients with Alzheimer’s dementia have deficits in new learning,whereas those with subcortical dementia have difficulty in retrieving informationpreviously learned. 31 Small but strategically located lesions can causeproblems in one aspect of memory but not others. Transient global amnesia isdiscussed in Chapter 6 as a reflection of several acute neurologic conditions ofshort duration. When an amnestic syndrome is suspected, all the stages ofmemory are assessed. A structured assessment is time-consuming and requiresexpertise. 32It is also important to define the characteristics of the emergence of memorydeficits. Amnesia due to stroke occurs suddenly. Amnesia from degenerativediseases emerges slowly. Table 13.6 displays the pattern of emergence of theamnestic disorders. 33