Chapter 183: The Neurologic Examination
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MENTAL STATUS EXAMINATION
- The bare minimum: During the interview, look for difficulties with communication and determine whether the pt has recall and insight into recent and past events.
The mental status examination is underway as soon as the physician begins observing and talking with the pt. The goal is to evaluate attention, orientation, memory, insight, judgment, and grasp of general information. Attention: ask pt to respond every time a specific item recurs in a list. Orientation: ask about the day, date, and location. Memory: ask pt to immediately recall a sequence of numbers and test recall of a series of objects after defined times (e.g., 5 and 15 min). Remote memory is also evaluated by assessing pt’s ability to provide a cogent chronologic history of the illness or personal life events. Recall of historic events or dates of current events can be used to assess knowledge. Evaluation of language function should include assessment of spontaneous speech, naming, repetition, reading, writing, and comprehension. Additional tests such as ability to draw and copy, perform calculations, interpret proverbs or logic problems, identify right versus left, name and identify body parts, etc., are also important.
A useful screening examination of cognitive function is the mini-mental status examination (MMSE), a 30-point test of cognitive function, with each correct answer being scored as 1 point. It includes tests in the areas of orientation (e.g., identify season/date/month/year/floor/hospital/town/state/country); registration (e.g., name and restate 3 objects); recall (e.g., remember the same three objects 5 minutes later); and language (e.g., name pencil and watch; repeat “no if’s and’s or but’s”; follow a three-step command; obey a written command; and write a sentence and copy a design).