Long-term deficit: advanced dementia, amnesia, dissociative disorder, movement disorder, previous strokeĪsk patient to repeat three words immediately and again in five minutesĪsk patient to sign his/her name while answering unrelated questions (each test must be tailored to the individual patient)Ībility of patient to recognize his or her place in time and spaceĪmnesia, delirium, dementia, mania, previous stroke, severe depression Procedural: ability to complete learned tasks without conscious thought Short-term deficit: amotivation, attention-deficit/hyperactivity disorder, dementia, inattention, substance use Inappropriate reading/writing level: dementia, depression, previous strokeĭeclarative: recall of recent and past events Inappropriate conversation: personality disorder, schizophrenia Slow or impoverished speech: delirium, depression, schizophrenia Show patient a common object (e.g., pen, watch, cellular telephone) and ask if he or she can identify it and describe how it is usedĪppropriateness of conversation, rate of speech (> 100 words per minute is normal < 50 words per minute is abnormal), reading and writing appropriate to education level Trail-making test: ask patient to alternate numbers with letters in ascending order (e.g., A1B2C3)Ībility to name objects and their function Testing each cognitive function involved in completing a taskĬlock drawing test: ask patient to draw a clock with hands set to 11:10ĭelirium, dementia, mood disorder, psychotic disorder, stroke Ordering and implementation of cognitive functions necessary to engage in appropriate behaviors Have you felt energized/out of control lately?Īkathisia: excessive motor activity (e.g., pacing, wringing of hands, inability to sit still)Īkathisia: anxiety, drug overdose or withdrawal, medication effect, mood disorder, parkinsonism, posttraumatic stress disorder, schizophreniaīradykinesia: psychomotor retardation (e.g., slowing of physical and emotional reactions)īradykinesia: depression, medication effect, schizophreniaĬatatonia: immobility with muscular rigidity or inflexibilityĬatatonia: schizophrenia/psychotic disorder, severe depressionĪbility to focus based on internal or external prioritiesĪttention-deficit/hyperactivity disorder, delirium, dementia, mood disorder, psychotic disorder

Mood disorder, schizophrenia, substance useĪffect: objective observation of patient's emotional state by the physician Mood: subjective report of emotional state by patientīody movements/making contact with others, facial expressions (tearfulness, smiles, frowns) Provocative: personality disorder or trait Poor eye contact: depression, psychotic disorder There are no guidelines to direct further testing in the setting of an abnormal mental status examination therefore, testing is based on clinical judgment.īody habitus, eye contact, interpersonal style, style of dressĪppearance: attention to detail, attire, distinguishing features (e.g., scars, tattoos), grooming, hygieneĭisheveled: depression, schizophrenia/psychotic disorder, substance useīehavior: candid, congenial, cooperative, defensive, engaging, guarded, hostile, irritable, open, relaxed, resistant, shy, withdrawnĮye contact: fleeting, good, none, sporadic The mental status examination is useful in helping differentiate between a variety of systemic conditions, as well as neurologic and psychiatric disorders ranging from delirium and dementia to bipolar disorder and schizophrenia. Each must be interpreted in the context of physician observation. These tools have varying sensitivity and specificity for neurologic and psychiatric disorders, but none are diagnostic for any mental status disorder. Physician judgment is necessary in selecting the most appropriate tool for an individual patient. Proprietary and open-source clinical examination tools are available, such as the Mini-Mental State Examination and the Mini-Cog. Multiple cognitive functions may be tested, including attention, executive functioning, gnosia, language, memory, orientation, praxis, prosody, thought content, thought processes, and visuospatial proficiency. The mental status examination includes general observations made during the clinical encounter, as well as specific testing based on the needs of the patient and physician.

Moca cognitive assessment norms