1、The Mental Status Examination(MSE)Mental Status Mental status is the total expression of a persons emotional responses,mood,cognitive function,and personality It is closely linked to the individuals executive functioning,i.e.motivation,initiative,goal formation,planning and performing,self-monitorin
2、g,and integration of feedback Quick Neurology Review Frontal lobe Speech formation(Broca area)Emotions/affect Drive Awareness of self Short-term memory Goal-oriented behavior Quick Neurology Review Parietal lobe Sensory perception Spatial sense and navigation Quick Neurology Review Temporal lobe Per
3、ception and interpretation of sounds Wernickes area Integration of behavior,emotion,and personality Long-term memory Quick Neurology Review Limbic system Survival behaviors(mating,aggression,fear,affection)Reactions to emotions,and expression of affect is mediated by connections of the limbic system
4、 and the frontal lobe Dementia Dementia is a clinical syndrome,characterized by deteriorating cognition,behavior,and functional independence It is usually related to obvious structural disease of the brain(most commonly atrophy)Dementia affects 3-11%of adults older than 65 Mnemonic for causes of dem
5、entia D:drugs and toxins E:endocrine M:metabolic and mechanical E:epilepsy N:nutritional and nervous system T:tumor and trauma I:infection A:arterial Delirium Delirium is different than dementia It is an acute confusional state accompanied by a disorder of perception Symptoms include alterations in
6、mental status(disorientation),attention span,sleep patterns,and affect Sudden and fluctuating Usually reversible Mental Status Examination The MSE is one component of an exam and may be viewed as the psychological equivalent of the physical exam It is an important component to a neurological evaluat
7、ion Factors affecting the MSE Culture and educational background of the patient What is abnormal for a person with high intellectual ability may be normal for a person of less education Patients with ESL may have difficulty with some components of the exam Major Components of the MSE 1.Appearance 2.
8、Motor 3.Speech 4.Affect&mood 5.Thought Content 6.Thought Process 7.Perception 8.Intellect 9.Insight Appearance Age Gender Race Body build Posture Eye contact Dress Grooming Manner Attentiveness to examiner Emotional facial expression Alertness Motor Behavior:Pleasant?Cooperative?Appropriate for the
9、particular situation?Hesitancy Agitation Abnormal movements Gait Catatonia Speech Rate Rhythm Volume Amount Articulation Spontaneity Affect and Mood Affect:How do they appear to you?Stability Range Appropriateness Intensity Mood:Dr.asks the patient directly how he/she feels Thought Content Suicidal
10、ideation Death wishes Homicidal ideation Depressive cognition Obsessions Ruminations Phobias Paranoid ideation Magical ideation Delusions Overvalued ideas Description of what the patient is thinking about Thought Process Associations Coherence Logic Stream Clang associations Perseveration Neologism
11、Thought blocking Attention Description of the way in which the patient thinks Perception Hallucinations Illusions Depersonalization Derealization dj vu jamais vu Intellect Global impression:average,above average,below average Insight Awareness of illness MSE The full MSE is a lengthy exam You assess
12、 many components of the MSE in your normal work up of a patient When you need to do a shorter neurological screening exam,you may shorten the MSE to the Mini Mental Status Exam(MMSE)MMSE Takes approximately 10 minutes The MMSE tests:Orientation Immediate and short-term memory Concentration Arithmeti
13、c ability Language Praxis(learning)MMSE Orientation:What is the(year)(season)(date)(day)(month)?Where are we?(state)(country)(town)(office)(floor)5 points Registration:Name 3 objects,taking 1 second to name each.Then ask the patient to repeat them.1 point for each correct.Attention and Calculation:A
14、sk the patient to count backwards from 100 in 7s.Stop after 5 answers.Alternatively,ask the patient to spell“world”backwards.1 point for each correct answer (5)1 point for each correct answer (5)1 point for each correct answer (3)1 point for each correct answer (5)MMSE Recall:Ask the patient for the
15、 3 objects named under“Registration”.Language:Point to two objects and ask the patient to name them(pen and watch).Ask the patient to repeat“No ifs,ands,or buts.”Ask the pt.to follow a 3-step command:“Take this paper in your right hand,fold it in half,and put it on the table.”Ask the pt.to read and
16、obey the following:“Close your eyes.”Write a sentence.Copy a drawing of intersecting pentagons.1 point for each correct answer (3)1 point for each correct answer (2)1 point for correct answer (1)1 point for each correct task (3)1 point for correct task (1)1 point for correct task (1)1 point for correct task (1)Total (30)Interpretation of the MMSE The traditional threshold for the MMSE is a score of 23 or greater Scores of 0-23 argue strongly for the diagnosis of dementia But,false-positive resul
