Familiar objects (coins, keys, paper clips)
Paper and pencil
Perform the mental status examination throughout the patient interaction. Focus on the individual’s alertness, orientation, mood, and cognition or complex mental processes (learning, perceiving, decision-making, and memory). Interview a family member or friend if you have any concerns about the patient’s responses or behaviors.
Use a mental status screening examination for health visits when no cognitive, emotional, or behavioral problems are apparent. Information is generally observed during the history in the following areas:
|Appearance and behavior|
|Mood and feelings|
|Thought process and content|
|Speech and language|
|State of consciousness|
|Ability to communicate|
|MENTAL STATUS AND SPEECH PATTERNS|
|Observe physical appearance and behavior|
|UNEXPECTED:Poor hygiene; lack of concern with appearance; or inappropriate dress for season, gender, or occasion in previously well-groomed patient.|
|EXPECTED:Patient expresses concern appropriate for emotional content of topics discussed.|
|UNEXPECTED:Behavior conveys carelessness, apathy, loss of sympathetic reactions, unusual docility, rage reactions, agitation, or excessive irritability.|
|EXPECTED:Erect posture and eye contact (if culturally appropriate).|
|UNEXPECTED:Slumped posture, lack of facial expression, excessively energetic movements, or constantly watchful eyes.|
|State of consciousness|
|EXPECTED:Oriented to person, place, and time; appropriate responses to questions and environmental stimuli.|
|UNEXPECTED:Disoriented to time, place, or person. Verbal response is confused, incoherent, or inappropriate, or there is no verbal response.|
|Investigate cognitive abilities|
Ask patient to remember and immediately repeat three unrelated words (e.g., red, plate, and milk). Ask patient to draw a clock face with numbers, then to place hands pointing to a specific time requested. Ask the patient to repeat the three words. (Borson et al, 2000)
All three words are remembered, and the clock face has all numbers in proper position and hands pointing to the requested time; or the clock face is normal and one or two words are recalled.
Clock face is not normal; words cannot be recalled. May indicate dementia.
Mini-Mental State Examination
Use this examination to quantify cognitive function or document changes.
Score of 21 to 30.
Score of 20 or less.
Use this test to evaluate mental status as a whole (motivation, alertness, concentration, short-term memory, problem solving). Ask patient to name 10 items in each of four groups: fruit, animals, colors, towns or cities. Give each item 1 point for a maximum of 40 points.
Able to categorize, count, remember items listed. Score of 25 or more points.
Score less than 15 points. Check for mental changes or cultural, educational, or social factors when score is 15 to 24.
Ask patient to describe analogies: first simple, then more complex.
What is similar about peaches and lemons, oceans and lakes, trumpet and flute?
An engine is to an airplane as an oar is to a _____?
What is different about a magazine and a telephone book, or a bush and a tree?
Correct responses when patient has average intelligence.
Unable to describe similarities or differences.
Ask patient to explain meaning of fable, proverb, or metaphor.
A stitch in time saves nine.
A bird in the hand is worth two in the bush.
A rolling stone gathers no moss.
Adequate interpretation when patient has average intelligence.
Unable to give adequate explanation.
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Ask patient to perform simple calculations without paper and pencil.
50 − 7, − 7, − 7, etc., until answer is 8.
50 + 8, + 8, + 8, etc., until answer is 98.
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