Introduction to higher cognitive functions

Question 1

What are higher cognitive functions?

Answer 1

Complex mental processes
Skills set of the brain
Perception, attention, learning, memory, decision making, language skills and reasoning

Question 2

Define cognition:

Answer 2

mental action or process of acquiring knowledge and understanding through thought, experience and the senses

Question 3

What is the general principle of higher cognitive functions?

Answer 3

requires the ability to process necessary information through multiple sensor inputs:

• inputs = sensory information
• processor = brain
• outputs = executive functions/actions (outputs are the things you selectively response to as you’ve chosen to be aware of them)

integrated processing - how the brain processes inputs and what outputs it sends out

Question 4

What does mindfulness do?

Answer 4

teaches you to recognise things that you aren’t necessarily aware of beforehand - taking a moment to become aware of other stimuli around you

Question 5

What is the cocktail party effect?

Answer 5

how you can know what your friends are saying when you are out at a busy bar and you’ve had a drink and there are lots of different stimuli yet you still manage to zone out other stimuli so you can focus on the conversation

Question 6

What is the stroop test?

Answer 6

stroop effect is the fact you can respond fast to words that are present in that colour compared to naming the colour of a word that isnt that word
Selective attention
Colours are not necessarily an automatic process like reading

Question 7

What are the key functions of the frontal lobe?

Answer 7

“basic computer”
Executive functions, thinking, planning, organising, decision making, problem solving, emotions and behavioural control and personality
Contains Broca’s area

Question 8

What are the key functions of the parietal lobe?

Answer 8

Perception, making sense of the world, arithmetic, spelling

Question 9

What are the key functions of the occipital lobe?

Answer 9

vision

Question 10

What are the key functions of the temporal lobe?

Answer 10

memory, understanding, language

contains Wernicke’s area

Question 11

What are the two areas involved in language?

Answer 11

Broca’s area: speech production

Wernicke’s area: speech comprehension

Question 12

What are specific language disorders?

Answer 12

Spoken word comprehension (understanding speech)- receptive language disorder

Written word comprehension (reading) - language processing disorder

Spoken word production (talking) and written word production (writing) - expressive language disorder

Question 13

What are the effects of Broca’s aphasia?

Answer 13

non-fluent / expressive / productive / motor aphasia

Impaired production of speech 
Severely limited speech output 
May have anomia 
Mainly content word (lack of function words)
Lack syntax
Frustration with difficulties- often using gestures to express themselves 
Comprehension is relatively normal 
impaired repetition 
Reading aloud is impaired 
Writing- poorly formed letters

Question 14

What are the typical lesions causing broca’s aphasia and what is the typical pathology?

Answer 14

Left posterior-inferior frontal cortex and underlying white matter
Stroke of upper division of left middle cerebral artery

Question 15

What are the effects of Wernicke’s aphasia?

Answer 15

Fluent / sensory / receptive aphasia

Severely impaired comprehension of spoken and written language
Impairment to location of memories of words
Fluent, socially conventional speech - meaningless though
Patient’s appear undisturbed by their difficulties but it can be very difficult for families
Use made up but similar sounding words
Repetition impaired
Reading aloud impaired
Well formed letters when writing

Question 16

What are the typical lesions causing Wernicke’s aphasia and what is the typical pathology?

Answer 16

Superior posterior temporal region including angular gyri - commonly subcortical lesion of temporal isthmus

Stroke of lower division of left middle cerebral artery

Question 17

What are the observations are you trying to attain in terms of speech and language in psychiatry?

Answer 17

Speech

• slowed
• fast
• disorganised

Language is expression of thoughts

• content (e.g. depressed, grandiose, paranoid)
• speed (e.g. poverty, mania)
• form of thought (schizophrenia, disorganised thinking)

Question 18

What is language an expression of?

Answer 18

it is an expression of what we are thinking therefore it can be an important indicator for a psychiatric problem
- people who are depressed tend to demonstrate changes in their language

Question 19

What brain functions are associated with the frontal lobe?

Answer 19

• voluntary movement
• language production
• comportment
• executive functions
• motivation

Question 20

What brain functions are associated with the temporal lobe?

Answer 20

• Audition
• Language comprehension
• Memory
• Emotion

Question 21

What does it mean by language dominance?

Answer 21

Left hemisphere is dominant for language in >90% of right handed people and 70% in left handed people

Question 22

How can left hemisphere dominance be demonstrated?

Answer 22

Through:

• aphasias
• wada test
• split brain patients
• neuroimaging studies
• brain stimulation studies

Question 23

What was phineas gage like post head injury?

Answer 23

Motor control, perception and language were all still intact
His QoL had deteriotated
General impairments in control (disinhibited, impulsive, antisocial, profane) with changes in mood and personality

Dysexecutive syndrome / frontal lobe syndrome / pseudopsychopathy

Question 24

What are the functions of the frontal lobe?

Answer 24

Cognition and memory
Ability to concentrate and attend, elaboration of thought “the gatekeeper” for judgement and inhibition, personality and emotional tracts
Motor cortex- voluntary motor activity
Premotor cortex - storage of motor patterns and voluntary activities

Language - motor speech

Question 25

What effects can damage to the frontal lobe cause?

Answer 25

Impairment of recent memory, inattentiveness, inability to concentrate, behaviour difficulties, difficulty in learning new information
Lack of inhibition (inappropriate social and/or sexual behaviour)
Emotional lability “flat” affect

Contralateral plegia / paresis
Expressive/motor aphasia

Question 26

What are the different types of attention?

Answer 26

Sustained attention
Selective attention - voluntary and reflexive (automatic)
Divided -resource allocation models
Switching attention

Some people are better than others at dividing their attention

Question 27

What is the central executive?

Answer 27

Integrating short term memory with our basic computer

• working / short term memory
• Acts like a coordination system for the brain’s attentional resources: - pholongical loop, visuospatial sketchpad, episodic buffer

Coordination of information from the frontal lobes

Question 28

What does it mean by episodic buffer?

Answer 28

can’t have too much in there at any one time otherwise things start dropping off

Question 29

What are the roles of the central executive?

Answer 29

Planning or decision making
Troubleshooting when the automatic processes run into difficulties
Novel situations (no prelearned response)
Dangerous or technically challenging situations - can override fears such as public speaking
Situations where there is a strong habitual response which needs to be overcome

Question 30

What are ways of testing frontal lobe function?

Answer 30

Wisconsin card sorting test

Tests set-shifting, abstract reasoning and problem solving

Question 31

What are the questions in the cognitive failures questionnare?

Answer 31

1) do you read something and find you havent been thinking about it and must read it again?
2) do you forget whether youve turned off a light or fire or locked the door?
3) do you fail to hear someone speaking to you when you are doing something else?
4) do you fail to see what you want in a supermarket (although its there)?
5) do you find yourself wandering whether you’ve used a word correctly?
6) do you accidentally throw away the things you want and keep what you meant to throw away?

Question 32

What is FAB?

Answer 32

frontal assessment battery

• assess similarities - e.g. in what way is a table like a chair
• verbal fluency
• motor series
• conflicting instructions (sensitivity to interference)
• go no go (inhibitory control)
• prehension behaviour (environmental autonomy)

Question 33

What happens to cognitive estimates in people with frontal lobe deficits?

Answer 33

produce widely abnormal estimates