PD 2

Mental status

Total expression of a person’s emotional response, mood, cognitive function, and personality

Cognition

ability to think, reason, and make judgement

Frontal lobe

Part of the brain involved in decision making, problem solving, ability to concentrate, and short term memory

Frontal lobe

What part of the brain involves expressing yourself in spoken and written words?

Frontal lobe

What part of the brain involves executing a purposeful motor act?

Frontal lobe

What part of the brain involves emotions, affect, drive, and self awareness?

Temporal lobe

What part of the brain involves emotional response/behavior and personality?

Temporal lobe

What part of the brain involves long term memory?

Temporal lobe

What part of the brain involves perceiving and interpreting sounds?

Frontal Lobes

What part of the brain do these test? Speech formation, working memory, repeating, judgement, set generation, completing a purposeful motor act.

Temporal lobe

What part of the brain involves understanding spoken and written words?

Wernicke’s Area

What part of the brain is responsible for receptive language; understanding spoken and written words. Located in temporal lobe

Broca’s Area

What part of the brain is responsible for expressive language/expressing yourself in spoken and written words. Located in frontal lobe

Broca’s

If ___ is broken, no words will be spoken

Parietal lobe

What part of the brain is responsible for perception and interpretation of sensory information?

Stereognosis

Recognition by touch. Tests parietal lobe

Occipital lobe

Which part of the brain involves vision, recognition of color, faces, objects, and perceiving motion?

30 years

When does speed of processing info and psychomotor speed start to decline?

20-30 years

Cognitive decline leading to dementia can occur over ___

Depression, schizophrenia, dementia, etc

What might poor or inappropriate grooming/hygiene in a previously well groomed patient represent?

1-sided neglect

In terms of grooming and hygiene, what might manifest with a lesion on the opposite parietal lobe?

Emotional status and affect

This part of the MSE notes carelessness/indifference, apathy, loss of sympathetic reactions, hostility, irritability, cooperation

Body language

What part of the MSE do we observe posture, eye contact, facial expressions, abnormal body movements?

Depression

What might poor posture or lack of facial expression and eye contact indicate?

Anxiety, metabolic disorder, drug effect

What might tense, anxious, or fidgety body language indicate?

Manic

What might singing, dancing, exaggerated movements indicate?

Dysphonia

Disorder of volume, quality, and pitch. Could be caused by disorders of larynx or vocal cords

Speech and language skills

What part of the MSE notes voice quality, inflection, articulation, comprehension, coherence, and aphasia?

Dysarthria

Defect in articulation. Associated with stroke, inebriation, cerebral palsy, or Parkinsons

Comprehension

What is assessed when we ask patient to follow one and two step directions?

Coherence

What do we evaluate if we note use of meaningless statements, rhyming words, or repeating others?

Incoherence

May indicate drug and alcohol intoxication, psych disorders

Aphasia

Inability to properly express oneself by speech or writing or comprehend spoken or written language

Aphasia

This might be caused by psychogenic, frontal or temporal lobe brain disease, motor impairment of face or tongue

Brocas aphasia

Impaired speech or writing

Wernicke’s aphasia

Inability to understand written or spoken words

Global aphasia

Loss of all language and comprehension

Emotional stability

Part of MSE that evaluates mood and feelings, thought content and process, and perceptual distortions or hallucinations

Mood

Internal mood or feeling described by a patient

Affect

Outward expression of an emotional response to an event

Apathy

Lack of interest, enthusiasm, or concern about a human being, a thing, or an activity

Depression, frontal lobe lesions

Mood and feeling abnormalities may indicate

Emotional/psych disorders

Abnormal thought process/content may indicate

Mood and feelings

Assessed for hopelessness, agitation, aggression, anger, euphoria, irritability, or wide mood swings

Auditory and visual

What hallucinations may indicate psych disorders, OBS, depression, acute intoxication, delirium, dementia

Alcohol withdrawal

Tactile hallucinations indicate this

Lethargy

Drowsy, responds on command then falls back to sleep, response appropriate

Obtunded

Responds on command, responds slowly with some confusion; decreased interest

Stupor

Brief arousal to pain, slow or absent response, minimal awareness

Coma

Unarousable and unaware, may posture to stimuli

Glasgow coma scale

Used to evaluate level of consciousness in person with head trauma or hypoxic event

Glasgow coma scale

Evaluates best eye opening response, verbal response, and motor response

3-15

Score range of glasgow coma scale

4 points

Max points for eye opening response on GCS

4 points

Max points for verbal response on GCS

6 points

Max points for motor response on GCS

Decorticate

Posturing in coma where arms come to the core

Decerebrate

Posturing in coma where arms extend at sides

Decorticate

Indicates a lesion of corticospinal tracts above brainstem

Decerebrate

Indicates lesion of brainstem

Head trauma, seizure, amnesia

Disorientation to person indicates these

Psych disorder, delirium, OBS

Disorientation to place indicates these

Anxiety, depression, delirium, OBS

Disorientation to time indicates these

Analogies

Part of cognitive function test where you ask patient what is similar or different about 2 objects

Comprehension, judgement, intelligence

What do analogies and abstract reasoning require?

Abstract reasoning

Ask patient to interpret a proverb or metaphor to assess this

Intellectual disability

A concrete but wrong response to abstract reasoning indicates

Mathematical calculations

Requires functional dominant hemisphere and average intelligence

Dementia, parietal lobe damage, cerebellar lesion, PN (peripheral neuropathy)

What does uncoordinated writing ability indicate?

Praxis

Ability to perform a motor activity on command

Apraxia

Inability to translate an intention into action

Dyspraxia

Difficulty translating an intention into action

Frontal or parietal lesions

Apraxia and dyspraxia can indicate these

Immediate recall

Repeat a sentence or set of objects

Occipital lobe

What part of the brain involves immediate recall?

Aphasia

Mirror writing or omissions during a writing ability test may indicate which condition?

Recent memory

Tested by showing patient 4 or 5 objects and having them list them 5 to 10 minutes later

Remote memory

Tested by asking the patient about verifiable past events

immediate and recent memory

Which type of memory loss is most characteristic of dementia or delirium?

Attention span

Asking a patient to repeat a short phrase or story or set of directions tests which cognitive function?

Judgement

Asking a patient's solution to a hypothetical situation tests which cognitive function?

higher cerebral function

What does judgement require?

Knowledge of current events

What requires intact orientation, recent memory, and abstract thinking?

Mini mental state exam (MMSE)

Templated tool that estimates cognitive function and documents changes

11

How many items in the MMSE?

30

Max score for MMSE

<20

MMSE score that may be associated with dementia

Mini cog

Tool for measuring cognitive function on a scale of 0 to 5