Phys · general-medicine
Neurological Examination — Speech and Higher Mental Function
Also known as speech examination · higher mental function · higher cortical function · cognitive assessment · aphasia examination · dysphasia · dysarthria · dysphonia · Broca aphasia · Wernicke aphasia · conduction aphasia · global aphasia · MMSE · MoCA · ACE-III · clock drawing test · mini-mental state examination · Montreal Cognitive Assessment
Classic DCE short-case routine for speech and higher mental function: the systematic six-step speech sequence, the aphasia classification (fluency, comprehension, repetition), dysarthria and dysphonia, the cognitive domains and their bedside tests (orientation, attention, memory, language, visuospatial, executive), the MMSE, MoCA and ACE-III, a say-aloud presentation template, examiner discussion and the pitfalls that fail candidates — for FRACP DCE, MRCP PACES and ABIM preparation.
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Meet the patient
Mrs Kaur, seventy-two, is two hours into a sudden torrent of fluent, confident speech that carries no meaning — word after word, grammatically formed, signifying nothing. She seems unaware anything is wrong. She manages "close your eyes" but not "point to the door, then the window," and she cannot repeat "no ifs, ands, or buts." The ward registrar calls it delirium.[1]
This is the short case that rewards structure, not signs. The two questions that decide Mrs Kaur's next hour decide every speech-and-cognition station: is this a language disorder (aphasia) or a motor speech disorder (dysarthria)? and if it is aphasia, where in the dominant hemisphere does the lesion sit? A fluent, empty, paraphasic speaker with poor comprehension and anosognosia is Wernicke aphasia from a dominant superior-temporal infarct until proven otherwise — and the stroke pathway is activated before any cognitive score is recorded.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Physician Medicine fellowship atlas.
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- [1]Folstein MF, Folstein SE, McHugh PR Mini-mental state. A practical method for grading the cognitive state of patients for the clinician J Psychiatr Res, 1975.PMID 1202204
- [2]Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment J Am Geriatr Soc, 2005.PMID 15817019
- [3]Hsieh S, Schubert S, Hoon C, Mioshi E, Hodges JR Validation of the Addenbrooke's Cognitive Examination III in frontotemporal dementia and Alzheimer's disease Dement Geriatr Cogn Disord, 2013.PMID 23949210
- [4]Brady MC, Kelly H, Godwin J, Enderby P, Campbell P Speech and language therapy for aphasia following stroke Cochrane Database Syst Rev, 2016.PMID 27245310
- [5]Park J, Jeong E, Seomun G The clock drawing test: A systematic review and meta-analysis of diagnostic accuracy J Adv Nurs, 2018.PMID 30047147