Mental Status Examination
- sum total of observation and impression of patient at the time of interview
Guidelines in MSE and MMSE
- inform patient that you will ask questions about mental state
- patient's consent
- comfortable seating arrangement
- conducive environment
- testing materials are ready
Outline of MSE
1) Appearance - physical impressions
2) Overt Behavior - motor behavior
3) Attitude
4) Speech
5) Mood - emotion that colors the person's perception of the world
6) Affect - present emotional responsiveness
7) Thought Process - form of thinking
8) Thought Content - ideas & beliefs
9) Perception - sensory systems (auditory, visual, gustary, olfactory, tactile)
10) Sensorium - consciousness (disturbances indicate organic brain impairment), orientation & memory, concentration & attention, reading & writing, visuospatial ability, abstract thinking, fund of knowledge (educ level and intelligence).
11) Judgment
a. Social Judgment - understand the likely outcome of his/her behavior
b. Test Judgment - predict what he/she would do in imaginary situations
12) Insight - understanding about being ill
a. Complete denial
b. Slight awareness
c. Blaming it on others
d. Cause by something unknown
e. Intellectual insight (aware but can't apply to future experiences)
f. True emotional insight (aware and motivated to change)
Mini-Mental Status Examination
- most widely used tool for screening cognitive impairment
- can be administered in 10 mins. with very little training.
Guidelines for MMSE
- inform patient that you will give questions to solve
- repeat questions a maximum of 3x
- 0 if no response and incorrect
- do not hint
- repeat question but do not explain
1) Orientation
- allow no more than 10 secs to reply
- what year? Month? Today's date? Day? Season? Pronvince? City/town? Country? Exact place? Floor/room?
2) Registration
- say 3 objects and ask the patient to remember the objects and name it again after few minutes.
3) Attention & Concentration
- subtract 7 from 100 (keep subtracting from what's left
- do not interrupt until 5 subtractions have been done.
- if he/she can't subtract, spell WORLD or KOPRA, and spell it backwards
4) Recall - ask again the 3 objects (allow 10 secs)
5) Language - point objects and ask him/her to name it (1 trial only)
6) Reading - read the words and do what it says
7) 3-Stage Command
8) Writing - write a sentence (with subject and predicate) no more than 30 secs, ignore spelling or grammar errors
9) Visuospatial Function - copying overlapping pentagon
Scores in the MMSE
24-30 - normal
20-23 - mild cognitive impairment
10-19 - moderate cognitive impairment
1-9 - severe cognitive impairment
0 - profound cognitive impairment
Limitations
- normal and abnormal not absolute
- may lead to false positive and false negative
- not sensitive enough
