Higher Cognitive Functions

Information and Vocabulary. Information and vocabulary, when observed clinically, provide a rough estimate of a person's intelligence. Assess them during the interview. Ask a student, for example, about favorite courses, or inquire about a person's work, hobbies, reading, favorite television programs, or current events. Explore such topics first with simple questions, then with more difficult ones. Note the person's grasp of information, the complexity of the ideas expressed, and the vocabulary used.

More directly, you can ask about specific facts, such as these:

The name of the president, vice president, or governor The names of the last four or five presidents The names of five large cities in the country

If considered in the context of cultural and educational background, information and vocabulary are fairly good indicators of intelligence. They are relatively unaffected by any but the most severe psychiatric disorders, and may be helpful for distinguishing mentally retarded adults (whose information and vocabulary are limited) from those with mild or moderate dementia (whose information and vocabulary are fairly well preserved).

Calculating Ability. Test the patient's ability to do arithmetical calculations, starting at the rote level with simple addition ("What is 4 + 3? ... 8 + 7?") and multiplication ("What is 5 X 6? ... 9 X 7?"). The task can be made more difficult by using two-digit numbers ("15 + 12" or "25 X 6") or longer, written examples.

Poor performance may be a useful sign of dementia or may accompany aphasia, but it must be assessed in terms of the patient's intelligence and education.

Alternatively, pose practical and functionally important questions, such as "If something costs 78 cents and you give the clerk one dollar, how much should you get back?"

Abstract Thinking. The capacity to think abstractly can be tested in two ways.

Proverbs. Ask the patient what people mean when they use some of the following proverbs:

A stitch in time saves nine.

Don't count your chickens before they're hatched. The proof of the pudding is in the eating. A rolling stone gathers no moss. The squeaking wheel gets the grease.

Concrete responses are often given by persons with mental retardation, delirium, or dementia, but may also be simply a function of limited education. Schizophrenics may respond concretely or with personal, bizarre interpretations.

Note the relevance of the answers and their degree of concreteness or ab-stractness. For example, "You should sew a rip before it gets bigger" is concrete, while "Prompt attention to a problem prevents trouble" is abstract. Average patients should give abstract or semiabstract responses.

Similarities. Ask the patient to tell you how the following are alike:

An orange and an apple A cat and a mouse A child and a dwarf

A church and a theater A piano and a violin Wood and coal

Note the accuracy and relevance of the answers and their degree of concreteness or abstractness. For example, "A cat and a mouse are both animals" is abstract, "They both have tails" is concrete, and "A cat chases a mouse" is not relevant.

Constructional Ability. The task here is to copy figures of increasing complexity onto a piece of blank unlined paper. Show each figure one at a time and ask the patient to copy it as well as possible.

The three diamonds below are rated poor, fair, and good (but not excellent).

(Strub RL, Black FW: The Mental Status Examination in Neurology, 2nd ed. Philadelphia, FA Davis, 1985)

In another approach, ask the patient to draw a clock face complete with numbers and hands. The example below is rated excellent.

These three clocks are poor, fair, and good.

(Strub RL, Black FW: The Mental Status Examination in Neurology, 2nd ed. Philadelphia, FA Davis, 1985)

If vision and motor ability are intact, poor constructional ability suggests dementia or parietal lobe damage. Mental retardation may also impair performance.

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