HIGHER CORTICAL FUNCTIONS

FUNGSI KORTIKAL LUHUR

Dr. Maja P.S., SpS

NEUROLOGY DEPARTMENT
MEDICAL FACULTY
UNSRAT MANADO
 HIGHER CORTICAL FUNCTIONS
Cerebral cortex contains:
* components functional systems
related to : - initiation of movement
- sensation from body
special sensory organs
* the SUBSTRATE for functions:
- comprehension
- cognition
- communication
 Higher cortical functions2

HCF related to :

1. frontal lobe functions

2. language & speech
3. Cerebral dominance
4. Memory & learning
5. Epilepsy
 1. FRONTAL LOBE FUNCTIONS

FRONTAL LOBE EXECUTIVE PART

HIGHER ORDER FUNTIONS:
* Reasoning - Abstraction
* Initiating activity
* Monitoring & shaping behavior
* Inhibiting maladaptive behavoir
* Prioritizing & sequencing actions
* Problem solving
* Coord.elementary motor&sensory funct
into a coherent&goal-directed stream of
behavoir
 Lobus Frontalis

- lobus yang paling besar

- 1/3 dari hemisfer cerebri

Terdiri dari 3 bagian besar :

Area motorik primer
Area premotorik
Area prefrontal
 Frontal lobe functions3

DAMAGE TO THE FRONTAL LOBES

Produce profound bahavior changes
* dorsolateral of temporal lobes
intellectual & cognitive function
* orbitomedial of frontal lobe
alteration in personality & mood
 Frontal lobe functions4

SEVERAL SYNDROMES:
- Dorsolateral:
indifferent, abulic, apathetic
- Orbitofrontal:
disinhibition :labil & irritable
- Medial:
akinesia & apathy
- Basal:
impairment of memory
 Premotor area Primary motor area
B6 B4

Central sulcus
Supplementary
motor area
(medially)

Frontal eye field

B8

Prefrontal area
B 9, 10, 11, 12
Lateral sulcus/
Sylvian fissure
Motor speech
area of Broca
B 44, 45
Phineas Gage
-Tertusuk batangan besi hingga menembus
tengkorak
- Penyembuhan fisik berlangsung sempurna
- Namus terjadi perubahan kepribadian secara
dramatis
 Status Mini Mental
Orientasi
Sekarang ini (thn)(musim)(bln)(tgl)(hari) apa ? Nilai . 5
Kita dimana (negara)(propinsi)(kota)(RS)(lantai)? Nilai . 5

Registrasi
Sebutkan 3 objek : tiap objek satu detik, pts disuruh meng-
ulangi nama 3 objek tsb, nilai 1 utk tiap nama objek yg benar
ulangi lagi sp pts menyebut dgn benar, catat juml pengulang-
an. Nilai .. 3

Atensi dan Kalkulasi

Pengurangan 100 dgn 7, nilai 1 utk tiap jawaban benar, stop
setelah 5 jawaban atau eja secara terbalik kata WAHYU.
nilai diberikan pd huruf yg benar sebelum kesalahan.
misal UYAHW = 2 nilai). Nilai 5
Mengenali Kembali
Pts disuruh menyebut nama 3 objek yg telah disebutkan
diatas. Nilai 3.
Bahasa
* Pts disuruh menyebut : pensil, buku. Nilai 2.
* Pts mengulangi kata : namun, tanpa dan bila. Nilai 1.
* Pts ikuti perintah ambil kertas itu dgn tangan kanan
anda, lipatlah menjadi dua, dan letakkan dilantai. Nilai 3.
* Pts disuruh membaca dan melakukan perintah kalimat :
Pejamkan Mata Anda. Nilai 1.
* Pts disuruh menulis secara spontan. Nilai 1.
* Pts disuruh menggambar bentuk spt ini. Nilai 1.
Jumlah Nilai : 30
 Galvastone Orientation & amnesia Test (GOAT)
1. What is your name ? (2) .. When were you born ? (4) ..
where do you live ? (4) ..
2. Where are you now ? City (5) .. Hospital (5) ..
3. On what date were you admitted to this hospital ? (5) ..
how did you get here ? (5) ..
4. What is the first event you can remember after the
injury ? (5)..
can you describe in detail (e.g., date, time, compenions) the
first event you can recall after injury ? (5) ..
5. Can you describe the last event you recall before the
accident ? (5) .. Can you describe in detail (e.g., date, time)
the first event you can recall before the injury (5) ...
6. What time is it now ? (-1 for each hour removed from
correct time to maximum of -5) ..
 Tes orientasi dan amnesia Galvestone
1. Siapa nama saudara ? .. (2)
kapan saudara dilahirkan ? .(4)
dimana saudara tinggal ? .(4)
2. Dimana saudara berada sekarang ? Kota .(5)
Rumah sakit . (5)
3. Kapan saudara dibawa ke RS ini ? .(5)
bagaimana caranya sdr dpt sampai disini ? .(5)
4. Kejadian pertama apakah yang sdr ingat setelah
kecelakaan ? . (5), jelaskan lebih terperinci (misal :
waktu, tempat, nama kawan) ? . (5)
5. Jelaskan kejadian terakhir apa saja yg sdr ingat seblm
kecelakaan ? . (5), dapatkah sdr jelaskan secara ter-
perinci (misal : waktu, tempat, nama kawan) ? . (5)
 Galvastone Orientation & amnesia Test (GOAT)
7. What day of the week is it ? (-1 for each day removed from
correct one) ..
8. What day of the month is it ? (-1 for each day removed from
correct date to maximum of-5) ..
9. What is the month ? (-5 for each month removed from
correct one to maximum of -15) ..
10. What is the year ? (-10 for each year removed from correct
one to maximum of -30) ..
Normal
80-100

Borderline
65-75

Abnormal
0-65

Tanggal
Jam
 Tes orientasi dan amnesia Galvestone .. (2)
6. Jam berapa sekarang ? (tiap beda jam nilai kesalah-
an 1, maksimal 5) .
7. Hari apa sekarang ? (tiap beda 1 hari nilai kesalah-
an 1) ..
8. Tanggal berapa sekarang ? (tiap beda 1 nilai kesalah-
an 1) ..
9. Bulan apa sekarang ? (tiap beda 1 bulan nilai kesalah-
an 5, maksimal nilai 15) ..
10. Tahun berapa sekarang ? (tiap beda 1 tahun nilai ke-
salahan 10, maksimal nilai 30)
Skor TOAG = 100 (jumlah nilai kesalahan)
Lamanya amnesia pasca cedera ditentukan sbg periode
Dimana TOAG belum mencapai nilai 75.
 2. LANGUAGE & SPEECH

LANGUAGE:
comprehension & communication of
ABSTRACT IDEAS
DYSARTHRIA
APHASIA
ALEXIA
AGNOSIA
ANOSOGNOSIA
APRAXIA
GERSTMANNS SYNDROME
?
 3. CEREBRAL DOMINANCE

HEMISPHERES IN CERTAIN FUNCTIONS

LEFT:
- Control language & speech
- Music understanding

RIGHT:
- Interpreting 3D images & spaces
- Arithmetic & design

RELATED TO HANDEDNESS
(70% LEFT BRAIN, broader planum temporale)
 4. MEMORY & LEARNING

3 TYPES OF MEMORY
1. Immediate recall (10 minutes)
- repeat, parrot-like,short series
- anatomy: auditory assc cortex
2. Short-term memory (1 hour)
- dj vu
- anatomy: deep temporal lobe
3. Long-term memory (many years)

4. Long-term potentiaton (LTP)

 5. EPILEPSY

CEREBRAL CORTEX DYSFUNCTION

alone or together with deeper structures
-- EPILEPSY : caracterized by
- sudden,
- transient alterations of brain funct.
- usually with motor-sensory-ANS-
psychic symptoms
- often acc.by alteration of consciousness
 Epilepsy2

CLASSIFICATION
* Primary Generalized Epilepsy
- absence (petit mal) sseizures
- myoclonic seizures
- atonic seizures

* Partial Epilepsy
- simple partial: - with motor sign
- with somatosensory sign
- with special sensory symptoms
- with ANS symptoms & signs
- with psychic symptoms
- complex partial: - simple partial at onset followed by
impairment of consciousness & automatisms
- Impairment of consciousness at onset:
 Epilepsy3

* Secondary Generalized Epilepsy

* Myoclonic astatic/atonic epilepsies
in children with MR
* Progressive myoclonic epilepsies
in adolescents & adults with
dementia
* Unclassified epilepsies
_____________________________________
Modified from the classification of the ILAE & the WHO