The mental status examination is underway as soon as the physician begins observing and talking with the pt. The goal of the mental status exam is to evaluate attention, orientation, memory, insight, judgment, and grasp of general information. Attention is tested by asking the pt to respond every time a specific item recurs in a list. Orientation is evaluated by asking about the day, date, and location. Memory can be tested by asking pt to immediately recall a sequence of numbers and by testing recall of a series of objects after defined times (e.g., 5 and 15 min). More remote memory is 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 vs. left, name and identify body parts, etc., are also important.
A useful screening examination of cognitive function is the mini-mental status examination (MMSE) (Table 191-1).
TABLE 191-1THE MINI-MENTAL STATUS EXAMINATION |Favorite Table|Download (.pdf) TABLE 191-1THE MINI-MENTAL STATUS EXAMINATION
| ||Points |
|Orientation || |
| Name: season/date/day/month/year ||5 (1 for each name) |
| Name: hospital floor/town/state/country ||5 (1 for each name) |
|Registration || |
| Identify three objects by name and ask pt to repeat ||3 (1 for each object) |
|Attention and calculation || |
| Serial 7s; subtract from 100 (e.g., 93–86–79– 72–65) ||5 (1 for each subtraction) |
|Recall || |
| Recall the three objects presented earlier ||3 (1 for each object) |
|Language || |
| Name pencil and watch ||2 (1 for each object) |
| Repeat "No ifs, ands, or buts" ||1 |
| Follow a 3-step command (e.g., "Take this paper, fold it in half, and place it on the table") ||3 (1 for each command) |
| Write "close your eyes" and ask pt to obey written command ||1 |
| Ask pt to write a sentence ||1 |
| Ask pt to copy a design (e.g., intersecting pentagons) ||1 |
|TOTAL ||30 |
The bare minimum: Check the fundi, visual fields, pupil size and reactivity, extraocular movements, and facial movements.
Occlude each nostril sequentially and ask pt to gently sniff and identify a mild test stimulus, such as soap, toothpaste, coffee, or lemon oil.
Check visual acuity with eyeglasses or contact lens correction using a Snellen chart or similar tool. Map visual fields (VFs) by confrontation testing in each quadrant of visual field for each eye individually. The ...