The take-home message is that diffuse or global functions like attention and language can influence the testing done to evaluate all cognitive and behavioral functions. The NBE cannot reliably elucidate focal neurobehavioral syndromes in the presence of grossly impaired attention. Therefore, you can often skip or abbreviate the bulk of what follows when attention or level of consciousness is grossly impaired. The MSE is worthless if someone really has a Wernicke's aphasia, since they may appear to have psychosis. If you detect this sort of problem, a language evaluation is needed so that you can gain better insight into the nature of their task failure.
Phonation is the ability to make any sounds.
Up to this point, everything we've discussed is fairly global or diffuse. But, with language, we see that hemispheric dominance is important. Most people are left hemisphere dominant for handedness and language functions, so the language tests rely primarily on the left side of the brain. Language assessment includes tests of fluency, naming, comprehension, and repetition, at a minimum. Sparse, effortful speech, often with obvious frustration, is a clue to dysfluency.