Caring for the Patient with Deficits of Higher Cerebral Function Some of the deficits described in this chapter are so complex that they may bewilder not only the patient and family but also the physician. It is imperative to carry out a systematic clinical evaluation in order to characterize the nature of the deficits and explain them in lay terms to the patient and family. Such an explanation can allay at least some of the anxieties, address the mistaken impression that the deficit (., social disinhibition or inability to recognize family members) is psychologically motivated, and lead to practical suggestions. | Chapter 027. Aphasia Memory Loss and Other Focal Cerebral Disorders Part 14 Caring for the Patient with Deficits of Higher Cerebral Function Some of the deficits described in this chapter are so complex that they may bewilder not only the patient and family but also the physician. It is imperative to carry out a systematic clinical evaluation in order to characterize the nature of the deficits and explain them in lay terms to the patient and family. Such an explanation can allay at least some of the anxieties address the mistaken impression that the deficit . social disinhibition or inability to recognize family members is psychologically motivated and lead to practical suggestions for daily living activities. The consultation of a skilled neuropsychologist may aid in the formulation of diagnosis and management. Patients with simultanagnosia for example may benefit from the counterintuitive instruction to stand back when they cannot find an item so that a greater search area falls within the immediate field of gaze. Some patients with frontal lobe disease can be extremely irritable and abusive to spouses and yet display all the appropriate social graces during the visit to the medical office. In such cases the history may be more important than the bedside examination in charting a course of treatment. Reactive depression is common in patients with higher cerebral dysfunction and should be treated. These patients may be sensitive to the usual doses of antidepressants or anxiolytics and deserve a careful titration of dosage. Brain damage may cause a dissociation between feeling states and their expression so that a patient who may superficially appear jocular could still be suffering from an underlying depression that deserves to be treated. In many cases agitation may be controlled with reassurance. In other cases treatment with sedating antidepressants may become necessary. The use of neuroleptics for the control of agitation should be reserved for refractory .
