Recent development of neurosurgery has been due to application of operative microsurgery, diagnostic imaging systems such as CT scan and magnetic resonance imaging (MRI) and technical advancement of skull base surgery. Moreover, development of neuronavigation and awake surgery for lesions in the speech and motor areas in the brain has made possible safe and accurate neurosurgery. In this review the authors have discussed identification of speech and motor areas in the cortex by functional MRI. We also described awake surgery for brain tumors in the speech and motor areas in order to avoid postoperative serious complications such as aphasia and hemiplegia.

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    The “higher brain dysfunction” illustrates various cognitive and behavioral consequences resulted from organic brain damage. We should note that this concept comprehensively involves various and heterogeneous brain-based symptoms. Among them, three types of problems were described which may frequently be consulted in psychiatric clinics. These included (1) subjective impairment, (2) the third party impairment, and (3) application of psychiatric handicap. On one hand, patients with such “higher brain problems” are difficult to be appropriately evaluated and treated even in psychiatry service. On the other hand, multi-disciplinary collaboration including medical doctors and paramedical staff is crucial for overcome patients' problems.

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    In the last few years, the term “higher brain dysfunction” is appearing as common word in news media and public administration. However, in medical fields there is no general agreement about the definition of this term. In the field of rehabilitation medicine, there have been many diagnostic and therapeutic trials in this subject for more than 20 years. In that effort, the major focus has been placed on discrete neurological symptoms such as aphasia, apraxia and agnosia due to cerebrovascular accidents. In recent years, because of advanced emergency medicine, the patients with diffuse brain injury, such as traumatic brain injury, are survived and come to rehabilitation scene. They tend to have cognitive, emotional and psychosocial disorders that are hard to be evaluated and treated. There are not sufficient volume and quality of system to support these individuals with “higher brain dysfunction”. The care-givers organization was established in 1998 and their publicity has led this sudden popularity of this term.

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    A study was undertaken to investigate the number and the life conditions of people with higher brain dysfunction due to neurological disease in the Tokyo metropolis. 1,234 cognitively disabled persons were reported. The number of people with higher brain dysfunction is estimated to be 4,177 persons in the Tokyo metropolis. The life conditions of people with higher brain dysfunction was investigated with the questionnaire and the interview. People with higher brain dysfunction showed a marked trend to live without social activities. Only 3.9% of people were known to be reinstated in his former post after the injury.

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    In Japan, various welfare services are provided for different kinds of disabilities based on the certification system. Even though, recently, it is claimed that the certification system is not sufficient for some of disabled people with higher brain dysfunctions, i.e. disturbances of frontal lobe functions. One of the reasons might be the lack of flexibility of the system applying for people with combined impairments of physical and mental functions. Considering these circumstances, Japanese government started the model project for people with higher brain dysfunctions since 2001. It will last three years and the committee of project is going to write a report in order to promote a policy for such people. In this article, the author introduced the general picture of model project.

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    The author, who dare not treat here the historical details themselves of neuropsychology, concentrated a focus in three topics which may have enough meaning today, and methodology or the way of thinking was argued. The First “Debates on Aphasia” (1908), the 2nd, “Disconnection Syndromes” raised by Geschwind (1965) and the 3rd, it refers to the new interpretation of “simultanagnosia” proposed from a point of cognitive neuropsychology. Three subtypes of simultanagnosia ( “semantic form” , “perceptual form” and “attentive form” ) were proposed from a clinical neuropsychological point of view.

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    Detailed bedside aphasia testing and its clinical implication were described. Aphasic symptoms are useful indicators in investigating patients having stroke. For example, side of hemispheric lesion, type of stroke, and lesion location are related to aphasic symptomatology.
    Bedside aphasia examination can be summarized as testing verbal output (spontaneous speech, naming, repetition), auditory comprehension, and writing and reading abilities. Attention should be paid not only upon deficits themselves but also upon error pattern in verbal realization and severity of the aphasic symptoms.

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    Since Liepmann advocated the concept of apraxia at the beginning of the 20th century, clinicians have faced many dilemma. Although interpretative corrections were proposed and some particular types were added, Liepmann's idea have been essentially uncorrected.
    The present methods of examining apraxia are fairly common. They ask the patient to demonstrate some actions with using no objects, such as playing social actions and some pantomimes in order to determine if he has ideomotor apraxia. They also ask the patient to use a specific single object as well as multiple objects in order to determine if he has ideational apraxia. Besides them, tasks of drawing, object-composition and dressing are provided. However, some neurologists indicated that the quality of error of actions demonstrated when using no objects does not differ from the ones demonstrated when using real objects. Other neurologists insisted that ideomotor apraxia is heterogenous. Same thing happened to ideational apraxia.
    Classifying the characteristics of error actions may bring about a new understanding of disorganized praxis. McDonald, et al. (1994), and Rothi, et al. (1988) presented their own error patterns as to ideomotor apraxia. My coworkers and I are categorizing the error characteristics of action/behavior which three so-called apraxic patients demonstrated while performing daily activities as well as testing-tasks.
    The context through which action/behavior is evoked has hardly been discussed. This viewpoint should be successfully incorporated into a more precise definition of dyspraxia in the future.

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    In order to understand the clinical pictures of visual agnosia, a good cognitive model of visual perception is needed. The Lissauer's classification of visual agnosia into two distinct types, apperceptive agnosia and associative agnosia, has now to be criticized from the current theory of visual perception. Since neurophysiological studies on animals and neuropsychological studies in men, both suggest the modular organization of visual information processing in brain, clinical examination of visual agnosia should be based upon a new cognitive model corresponding to the parallel information processing of visual perception.

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    Basic memories essential to human cognitive activities can grossly be divided into five types, i. e. working, episodic, prospective, semantic, and procedural memories. Their neuropsychological characteristics are briefly outlined. If we place these memories in temporal perspective according to their roles in our daily life, the episodic, semantic and procedural memories have such functions as to formulate the basis of personal identity, working memory to cope with the present, and prospective memory to bridge between the present and future. Cerebral basis of these 5 types of memories are also discussed.

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