Descriptive Psychopathology: The Signs and Symptoms of ...

328 Section 3: Examination domainsProcedural memoryProcedural memory is information and motor-related skills that are learnedthrough repeated exposure and practice, such as riding a bicycle and performingthe medical physical examination. Unlike declarative memory, the acquisition ofprocedural memory cannot be demonstrated by describing what is done, but onlyby performing the procedure. The carrying out of the task or procedure demonstratesthe learning, thus procedural memory is implicit memory. Proceduralmemory is assessed by asking the patient to demonstrate previously learned skills.Free recallFree recall is remembering spontaneously without cues. Free recall is demonstratedwhen the patient relates his past hospitalizations and treatments withoutundue prompting. Free recall is influenced by the state of emotion. Being sad isassociated with the spontaneous recollection of unhappy experiences, while beinghappy is associated with the recall of happy events. 41RecognitionRecognition is remembering from cues. Examples are the patient remembering apast medication only when the examiner mentions it, recalling rehearsed itemsonly when the examiner gives the patient several choices, and identifying the itemson the similarities test only when the examiner provides the category (e.g. “Theywere tools” to cue the similarity hammer–chainsaw). Persons with cortical dementiassuch as in the early stages of Alzheimer’s disease have impaired free recall andrecognition. Cueing does not help. Persons with subcortical dementias such as inBinswanger’s disease (subcortical ischemic disease) or Parkinson’s disease haveimpaired free recall but adequate recognition with cueing.Assessing for cerebral hemisphere diseasePatients with traumatic brain injury, stroke, space-occupying lesions, andseizure disorder often have circumscribed lesions and corresponding cognitivedysfunction. Bedside tests of left cerebral hemisphere functioning are displayedin Table 13.7. They reflect the substantial language functioning of the lefthemisphere.Table 13.8 displays bedside cognitive tests of right cerebral hemispherefunctioning. 42Distinguishing cortical from subcortical disease 43There are characteristically different behavioral changes associated with corticaland subcortical disease. The region of dysfunction shapes differential diagnosis.