Cerebral Cortical Examination
Vernon M Neppe MD, PhD,FRCPC, FFPsych, MMed
BRIEF INTRODUCTION TO THE BEHAVIORAL NEUROLOGICAL
EXAMINATION
The neuropsychiatric mental status
or behavioral neurological examination interfaces
between psychiatry and neurology. Behavioral neurological
examination consists specifically of the following
evaluations of:
- Consciousness
- Orientation for time, place, and space
- Evaluation of speech, i.e. dysphasia, dysarthria,
dysphonia
- Evaluation of praxis
- Evaluation of gnosis, i.e. recognition, interpretation
and organization of percepts - agnosias
- Evaluations of memory
- Intelligence - verbal
- Calculation
- Melodic functions
- Frontal-temporal functioning
Assessment of the neuropsychiatric
mental status of the patient is vital in any patient
who may exhibit features of possible coarse neurobehavioral
disease. One rapid but very inadequate method has
involved the 30 point Folstein Mini-Mental Status
Examination (neither specific, nor sensitive).
A very promising instrument is the BROCAS SCAN
(Screening Cerebral Assessment of Neppe). This
takes 15-30 minutes and involves 40 items. The B of
the term BROCAS refers to behavior, and all
facets of the Mental Status Examination are compared
with the behavioral component. The ROCAS items are
made up of two each of R-O-C-A-S: recall, recognition,
orientation, organization, concentration, calculation,
apraxia, agnosia, speech and sensory motor reflex.
A Clinical BROCAS SCAN exists. Organic mental disorders
are a heterogeneous group,of conditions which reflect
differences in localization, mode of onset, progression,
duration and nature of underlying pathophysiological
processes. Organic mental disorders may occur at any
age, but many are more prevalent in the population
over 60 years of age. Patients with these conditions
are particularly relevant for the BROCAS SCAN.
Patients with these conditions are particularly
relevant for the
BROCAS SCAN
