Anomia is the inability to generate the name of an object or item presented to a patient. Confrontational naming is often tested as a standard portion of the neurologic examination of mental status. While there are several standardized tools for testing of naming ability (such as the Boston Naming Test and the NIH Stroke Scale naming cards), many Neurologists and other practitioners use readily available everyday objects to test patients at the bedside or in the office. There is a distinction made between “high frequency” and “low frequency” names; individuals with naming ability will lose the ability to identify low frequency objects first, meeting criteria for a “mild anomia” which may indicate a degree of subtle cognitive deficit.
The two objects I have seen physicians use most often at the bedside are wrist watches and pens (followed by eye glasses for those who wear them). The physician will first start by asking the patient to identify the entire object (e.g. watch, pen) and then ask them to identify specific parts. However, not surprisingly, there is considerable variation in the design of watches (especially between analog and digital watches) and pens (spring-loaded pens versus capped pens), and there is likely some variability in cultural knowledge regarding the ability to identify the “low frequency” components of each.
However, sometimes even physicians will make mistakes in identifying the individual parts of each object! If you plan to use either object for testing naming, use the following as a guide:
Physicians are more likely to wear analog wrist watches which are seen as more professional than digital watches (which typically are worn by children or for sport situations). I focus on analog watches here.
Band – also known as the bracelet or strap, this is a high frequency component that is used to secure the watch to the wrist
Face – medium to high frequency component, the part of the watch with the numbers and markers. The surface under the watch hands is called the dial.
Hands – medium to high frequency component, the linear bars that turn and point toward the individual numbers which are used to designate the current time
Marker – low frequency, the design element that designates time intervals (five minute intervals, fifteen minute intervals, hours), often a small dot or line
Crown – low frequency, the cap on the side of the watch that is pulled up in order to alter the date wheel or time setting. The cap sits atop the stem and tube.
Stem and Tube – very low frequency, invisible when the watch is in a normal functioning position. This component sits under the crown and is only visible when the crown is pulled outwards. This connects to the internal mechanisms that adjust the date wheel and time.
Crystal – low frequency, the clear covering sitting above the face of the watch.
Bezel – low frequency, the outer ring with indentations or numbers that count or providing markings from 0 to 60. The bezel holds the crystal in place and also provides a time reference for divers to help them determine how much air remains in their tanks. There is considerable variation in bezel designs which are sometime fixed or they can rotate clockwise, counterclockwise, or both.
Date Wheel – low frequency, an indicator for the date of the month. Sometimes the date wheel window will have a magnifying lens above it called the cyclops.
Lug – very low frequency, the metal pieces that project from the main body of the watch and secure it to the band (specifically, the band end piece)
Case – also known as the casing, low frequency, the back of the watch which is lifted off to access the internal workings of the watch and battery compartment. The casing sometimes will have the model and serial number listings (if not located on the lug).
There are many different pens used by physicians, the most complicated being fountain pens which have dozens of components (nibs, cylinders, ferrules, feeds, levers, derbies, screw rings, press bars, sacs, etc.). However, considering how often pens are lost and “borrowed,” most probably rely on a steady supply of cheap, disposable pens. For simplicity, I’ll demonstrate names with a push-button pen here.
Point – also known as the tip, high frequency, the part of the pen through which ink is delivered to the page
Clip – medium to high frequency, the part of the some pens that will hold the pen in place in a (white) coat pocket
Barrel – low frequency, the main body of the pen (with many different names depending on the type of pen)
Push Button – medium to low frequency, the part of the pen that is pressed to exposed the point
Joint – low frequency, the part between the upper and lower halves of the body of the pen which connects them
Since most physicians are unlikely to deconstruct their pens at the bedside, I won’t describe the thrust tube or ink cartridge.