Method for predicting the degree of affected disorders of the highest cerebral functions

FIELD: medicine, neurology.

SUBSTANCE: by the table of quantitative evaluation of affected praxysis and gnosis as the value of cerebral corical disorders and degree of dementia manifestation level one should calculate in points these disorders. Moreover, if total value is above 24 points one should diagnose no disorders, if 20-23 points - light disorders, if 10-19 points - moderate disorders, and if below 9 points - pronounced functional disorders are stated upon.

EFFECT: higher accuracy of diagnostics.

1 ex, 1 tbl

 

The invention relates to medicine, namely to neurology.

According to the patent information search is not detected quantitative methods of assessing praxis and gnosis, this issue is only a qualitative assessment of these two mental spheres, components together with speech, memory and intellect of the higher cerebral functions (IMF) of a person.

With the defeat of the parietal-temporal-occipital region of the dominant hemisphere occurs syndrome apraxia (kinesthetic apraxia by A.R. Luria, “fundamentals of neuropsychology”, Moscow, 1973). For example, the defeat of field 4 prematernal cortex anterior to the region of the hands causes loss of accumulated motor engrams for hands and, consequently, the loss of the subtle and complex hand movements (PBUs, “Topical diagnosis in neurology”, Moscow, 1996). With the defeat of the frontal lobe (field 6, 8, 44) observed frontal apraxia syndrome kinetic apraxia by A.R. Luria (Pulatov A. M., Nikiforov A.S. “Neurology”, Dushanbe, 1990). To identify apraxia (motor, ideational and structural) the patient is encouraged to perform different actions on the job or by imitation: to show how to put the thread a needle, to dress, to close the door, to produce a variety of facial movement; to hammer in a nail, put blocks or matches a specific shape, etc. (Emmortal, VMotion, Overose, “Fundamentals neurologist and”, T.1, N.Novgorod, 1998) thus determined, may or may not do the job the patient.

For tests of visual gnosis is asked to call the displayed objects - a book, a Cup, etc. Ensuring the safety of the patient auditory function, investigate auditory gnosis, offer the patient with closed eyes to name the sources of noise is the ticking, a knock on the door and others (Eyisi, “Neurology”, M, 2000; Sam, “Topical diagnosis of diseases of the nervous system”, St. Petersburg., 2000). Visual agnosia occur with lesions of the occipital sections of the crust. Auditory agnosia occur with lesions of the temporal lobe in the region of the brains of Gesla. (Gasimov, DIN “Differential diagnosis of nervous diseases”, M, 2001).

Gustatory and olfactory agnosia are rare (Loads, “Pediatric neurology”, M, 1984).

With the defeat of nadreau gyrus, especially the right, the patient loses the sense of his own body (agnosia schema of the body or autotopagnosia). He also may not know the irritation of your own fingers (finger agnosia) and does not differentiate between the right and left half of his body (Namusan, Aventurescence et al. “Nervous diseases”, M., 1997).

When conducting research, some authors use test “summary scale mental status”. Mini-Mental State Examination). MMSE) [Folstein et al., 1975]). Attest has a high specificity, but it is not investigated auditory gnosis, motor and ideational praxis, anosognosia, autotopagnosia, stereognosis. All questions in this test aims to examine the function only certain areas of the dominant hemisphere and not give a complete picture of the violations of the Navy.

Estimation of a condition of the higher brain functions, namely praxis and gnosis, greatly facilitates the diagnosis. However, as the analysis of educational and scientific literature, this issue has no clear complete diagrams with a point estimate of praxis and gnosis, is only a qualitative assessment of these two mental spheres of the Navy. In research and in clinical practice sometimes requires a quantitative analysis of changes in praxis and gnosis, especially in the diagnosis of dementia.

The technical result of the proposed method for the diagnosis of severity of violations of the Navy is to count the points to improve the accuracy of diagnosing disorders of the Navy, namely praxis and gnosis, as an indicator of cerebral cortical disorders and the severity of dementia.

The essence of the proposed method lies in the fact that the survey is conducted praxis and gnosis on the scheme and the scoring table. If the total score 24-26 points is the norm, 20-23 points - light violations, 10-19 points - moderate violations 0-9 points - you the Agen violations praxis and gnosis (table).

In the case of diagnostic Dement conditions and detection in a patient with cognitive impairment with severe disorders of memory, intellect, violations of regulation and planning and obvious violations of praxis and gnosis below 9 points - the patient is established dementia. In the case of mild cognitive disorders assessment praxis and gnosis 10-19 points diagnose predementia condition (cognitive decline or “mild” dementia).

In the case of research praxis and gnosis for the establishment of localization of cerebral cortical disorders with a quantitative assessment of the Gnostic and dyspraxics disorders below 9 points can be assumed multifocal or diffuse cortical breach. Scheme of examination praxis and gnosis consists in the following:

1. Motor praxis.

A. Repetition of movements of the doctor - the raising and lowering of the arms, the hands behind the head, arms cross on chest, fingers shrink in the castle (3 credits quickly and correctly, 2 points slowly and correctly, 1 point - with hints of the doctor or repeat an action, 0 points - false).

B. action in order to wag your finger, wave goodbye, to cross his arms on his chest, put your legs (3 credits quickly and correctly, 2 points slowly and correctly, 1 point - with hints of the doctor, 0 points - false).

2. dietary praxis.

A. Manipulation with real objects, to fasten a button, comb your hair, take off a sweater or jacket (3 credits quickly and correctly, 2 points slowly and correctly, 1 point - with hints of the doctor, 0 points - false).

B. Action with imaginary subjects are asked to show how to eat with a spoon, drink from a glass, as a hammer in a nail (3 credits quickly and correctly, 2 points slowly and correctly, 1 point - with hints of the doctor, 0 points - false).

3. Constructive praxis.

Add shapes (snowflake, home, flag) from sticks or matches (3 credits quickly and correctly, 2 points slowly and correctly, 1 point - with hints of the doctor, 0 points - false).

4. Hearing gnosis - learn the sound of knocking at the door, ticking, ringing glass glass (2 points - recognition, 1 point - with hints of the doctor, 0 points - nieuznawaniu).

5. Visual gnosis - after reviewing the submitted photos to make them from 8 exploded parts (5 points 15 sec, 4 points - 20 sec, 3 points for 30 seconds, 2 points - 1 min, 1 point more than 1 min, 0 points - not coped with the task).

6. Stereognosis (3 units - full recognition, 2 points - description of properties 1 point - no description 0 points - no feelings).

7. The body schema requested by the doctor to show the right hand, foot, left hand, foot (2 points - correctly, 1 point - with hints of the doctor, 0 points - false).

8. Realizing its the th disease (anosognosia - 0 points incomplete comprehension - 1 credit, full awareness 2 points).

Clinical example

Patient K., 60 years old, retired. Hospitalized at the insistence of his wife for examination and treatment. Diagnosis: Parkinson's disease.

Complaints not actively imposes. Headaches, dizziness, noise in the head denies. Deterioration of memory and attention special no complaints, thinks that he's all right. While watching movies sometimes watery.

Medical history: the last 3 years she often did he comments on the fact that he slowly began to walk to face and for it to not have time. “His legs are bad to listen to”, there was a small tremor in his hands.

The personal history: Born in a family of 4 children, 3 of them on the account. In childhood from their peers did not lag behind, graduated from 8th grade. Worked at a brick factory, a stone Mason. for 3 years he served in the SA at the headquarters of the Army radio operator in Western Ukraine. for 36 years he worked as a collector in the Bank. Married 30 years, has 2 grown daughters. Alcohol was 16-17 years old in moderation on holidays. Smokes1/2packs a day. The mother of the patient was shaking hands and head, one brother died of a stroke, the other was treated at the psychiatrist. Neurological status: overall condition is satisfactory. Palpebral fissure D=s Reaction to accommodation and convergence is reduced. The expression sluggish. But what about the-lip folds D=S. Hypomimia. The oiliness of the face. Tendon reflexes D=S. Increased muscle tone type gears. The tremor in his hands on account type coins. The position of the petitioner”. Gait with small steps propulsive. Detected motor clumsiness, stiffness. In the place, time, self oriented approximately. All kinds of memory is reduced. Obsessive.

Psychological examination.

Table Schulte: run time 5 times more than normal. When techniques for the study of thinking - the job does not understand. Test Luscher: egocentric resentment, a sense of isolation. Restless tension.

Research praxis and gnosis.

1. Motor praxis.

A. Repetition of movements of the doctor - the raising and lowering of the arms, the hands behind the head, arms cross on chest, fingers squeeze into the lock (1 point - with hints of the doctor or repeat an action).

B. action in order to wag your finger, wave goodbye, to cross his arms on his chest, put one leg on the (0 points - false).

2. Ideational praxis.

A. Manipulation with real objects, to fasten a button, comb your hair, take off a sweater or jacket (2 points slowly and correctly).

B. Action with imaginary subjects are asked to show how to eat with a spoon, drink from a glass, as a hammer in a nail (1 point from under the Kazakh as foreign languages physician).

3. Constructive praxis. Add shapes (snowflake, home, flag) Popsicle (0 points - false).

4. Hearing gnosis - learn the sound of knocking at the door, ticking, ringing glass glass (1 point - with hints of the doctor).

5. Visual gnosis - after reviewing the submitted photos to make them from 8 exploded parts (0 - failed).

6. Stereognosis (2 points - description of properties).

7. The body schema requested by the doctor to show the right hand, foot, left hand, foot touch left, right hand to my forehead, to the left, the right ear (1 point - with hints of the doctor).

8. Awareness of their illness (anosognosia - 0 points).

The overall score praxis and gnosis - 8 points, together with the results of the survey of other areas of the Navy indicates the presence of dementia.

A method for diagnosing the degree of

the severity of the violations

the higher brain functions.

Table 1

Quantitative assessment of disorders of praxis and gnosis
Navy0 points1 point2 points3 points4 points5 points
Motor praxis Andwrongwith the help of a doctor or repeat an actionslowly and correctlyquickly and correctly --
Motor praxiswrongwith hints of the doctorslowly and correctlyquickly and correctly--
Ideational praxis Andwrongwith hints of the doctorslowly and correctlyquickly and correctly--
Ideational praxiswrongwith hints of the doctorslowly and correctlyquickly and correctly--
Constructive praxiswrongwith hints of the doctorslowly and correctlyquickly and correctly--
Hearing gnosisnieuznawaniuwith hints of the doctorRecognition after repeatingQuick recognition--
Visual gnosisFailedMore than 1 min30 sec-1 min20-30 sec15-20 sec10-15 seconds
Stereognosisthe lack of sensationno descriptiondescription of propertiesfull recognition- -
The body schemawrongwith hints of the doctorcorrectly---
Awareness of their diseaseanosognosiaincomplete comprehensionthe full realization---
Total points01020242526

The way to diagnose the higher brain functions, including the use of methods of research praxis and gnosis, characterized in that table quantitative evaluation of disorders of praxis and gnosis shall count in points violations praxis and gnosis, while if the total points score is above 24 points, diagnose the absence of violations of, if 20-23 points - light violations, if 10-19 points - moderate violations, if below 9 points - expressed disorders of praxis and gnosis.



 

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