The patient’s attention span is assessed first; an inattentive patient cannot cooperate fully and hinders testing. Any hint of cognitive decline requires examination of mental status ( see Examination of Mental Status Examination of Mental Status ), which involves testing multiple aspects of cognitive function, such as the following:
Orientation to time, place, and person
Attention and concentration
Verbal and mathematical abilities
Loss of orientation to person (ie, not knowing one’s own name) occurs only when obtundation, delirium Delirium Delirium is an acute, transient, usually reversible, fluctuating disturbance in attention, cognition, and consciousness level. Causes include almost any disorder or drug. Diagnosis is clinical... read more , or dementia Dementia Dementia is chronic, global, usually irreversible deterioration of cognition. Diagnosis is clinical; laboratory and imaging tests are usually used to identify treatable causes. Treatment is... read more is severe; when it occurs as an isolated symptom, it suggests malingering.
Insight into illness and fund of knowledge in relation to educational level are assessed, as are affect and mood Overview of Mood Disorders Mood disorders are emotional disturbances consisting of prolonged periods of excessive sadness, excessive joyousness, or both. Mood disorders can occur in children and adolescents (see Depressive... read more . Vocabulary usually correlates with educational level.
The patient is asked to do the following:
Follow a complex command that involves 3 body parts and discriminates between right and left (eg, “Put your right thumb in your left ear, and stick out your tongue”)
Name simple objects and parts of those objects (eg, glasses and lens, belt and belt buckle)
Spatial perception can be assessed by asking the patient to imitate simple and complex finger constructions and to draw a clock, cube, house, or interlocking pentagons; the effort expended is often as informative as the final product. This test may identify impersistence, perseveration, micrographia, and hemispatial neglect.
Praxis (cognitive ability to do complex motor movements) can be assessed by asking the patient to use a toothbrush or comb, light a match, or snap the fingers.
(See also Approach to the Patient With Mental Symptoms Routine Psychiatric Assessment Patients with mental complaints or concerns or disordered behavior present in a variety of clinical settings, including primary care and emergency treatment centers. Complaints or concerns may... read more and Introduction to the Neurologic Examination Introduction to the Neurologic Examination The neurologic examination begins with careful observation of the patient entering the examination area and continues during history taking. The patient should be assisted as little as possible... read more .)