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OVERVIEW
There are standardized forms that can be used to complete a mental status exam (that are useful when trying to compare standardized scores) with one example being the Montreal Cognitive Assessment (MOCA) that can be found here.
With this in mind, it is up to you as the individual working the patient up, to decide which elements of the exam will be the most useful. The below guide focuses on the an abridged mental status exam, that follows an intuitive order. We can conduct this exam in the order we would present the patient, and the first three items are the most important to conduct first simply because the integrity of the rest of the exam hinges upon them (an unconscious, inattentive, language challenged individual will have unreliable exam results).
**Introduce the exam and why you are doing it, always bring it back to the chief complaint. If a patient has a neurological issue this is easy to make the connection. If they have something seemingly unrelated stress that it is important to always assess for neurological issues given that it can be implicated in their specific chief complaint.
LEVEL OF CONSCIOUSNESS
This is the first thing one should notice:
– Is the patient awake and alert?
– If the patient is asleep/distracted will a soft stimulus (i.e. whisper) arouse them?
– If a soft stimulus does not work, titrate up the stimulus (i.e. working up to yelling) to assess if it is possible to arouse the patient. Take note of how much effort it takes to arouse patient (you will want to report this in certain instances)
ATTENTION/CONCENTRATION
Pick one test to use and get good at it (use the same test with all of your patients so you “master” its introduction, execution and interpretation).
-Ex. Serial 7s seems like a good go to. Count back from 100 by 7
LANGUAGE
Up until this point it will be important to be assessing for comprehension etc. To further investigate
– Have the patient repeat back 1 or 2 sentences: “The quick brown fox jumped over the lazy dogs” or “The cat hides under the chair when the dog is in the room.
– Have the patient name articles of clothing or items in the room to assess naming ability
– Fluency can be assessed if dementia is a concern (or things like it). Name as many words as you can think of that start with F, A, or S.
– Can test reading/writing as well if needed.
ORIENTATION
If time permits, ask if the patient knows who they are, where they are, and what the date is (including the year). Patients who know this information are said to be oriented x3.
One could also ask about general info/semantic memory (current president, past presidents, etc) if time permits.
MEMORY
Introduce 4-5 words (ex. face, velvet, church, daisy, red) and have the patient repeat them back to you 1-2 times until they have the words memorized.
-Ask the patient to recount these words back to you ~3-5 min later (at end of mental status assessment)
CLOCK DRAWING TEST
Have the patient draw a clock showing a particular time (i.e. 10:30)
CALCULATIONS
Have the patient do some calculations (rigor will depend on the patient you have).
– How many quarters are there in $ 6.75?
– What is 15% of 120?
SIMILARITIES/DIFFERENCES
Look to see if the patient employs intuitive abstraction (similarities and differences that one would expect for them to notice)
-How are apples and oranges similar? How are they different?
MOOD/AFFECT
Mood is to affect as climate is to weather. A patient’s mood is their general disposition, while affect is their current presentation in the moment (i.e. a generally relaxed patient is acting very apathetic).
-How have your spirits been as of late?
BEHAVIOR
One should always be assessing for the patients demeanor, cooperativeness, emotional lability, etc.)
*Don’t forget to ask about the memory recall! Face, velvet, church, daisy, red
Page Updated: 01.20.2016