How to assess mental status

[Tariq Zaki]

The patient’s attention span is assessed first; an inattentive patient cannot cooperate fully and hinders testing. Any hint of cognitive decline requires examination of mental status (see Examination of Mental Status), which involves testing multiple aspects of cognitive function, such as the following:

Orientation to time, place, and person
Attention and concentration
Memory
Verbal and mathematical abilities
Judgment
Reasoning

Loss of orientation to person (ie, not knowing one’s own name) occurs only when obtundation, delirium, or dementia is severe; when it occurs as an isolated symptom, it suggests malingering.
Insight into illness and fund of knowledge in relation to educational level are assessed, as are affect and mood. Vocabulary usually correlates with educational level.
The patient is asked to do the following:

Follow a complex command that involves 3 body parts and discriminates between right and left (eg, “Put your right thumb in your left ear, and stick out your tongue”)
Name simple objects and parts of those objects (eg, glasses and lens, belt and belt buckle)
Name body parts and read, write, and repeat simple phrases (if deficits are noted, other tests of aphasia are needed)

Spatial perception can be assessed by asking the patient to imitate simple and complex finger constructions and to draw a clock, cube, house, or interlocking pentagons; the effort expended is often as informative as the final product. This test may identify impersistence, perseveration, micrographia, and hemispatial neglect.
Praxis (cognitive ability to do complex motor movements) can be assessed by asking the patient to use a toothbrush or comb, light a match, or snap the fingers.
(See also Approach to the Patient With Mental Symptoms and Introduction to the Neurologic Examination.)