FUNCTIONAL ANATOMY TEMPLATE: NEUROLOGICAL MENTAL STATUS EXAMINATION
Having a structured, systematic approach to the neurological mental status examination can greatly improve our diagnostic acumen. Because this examination is long and complex, it helps to have a template. Unlike the mini-mental status examination, this template is organized by functional anatomy.
- GLOBAL BRAIN FUNCTION
- Arousal – alert (lethargy = drifts off, obtunded = difficult to arouse, stupor = requires constant vigorous stimulation, coma = unarousable. If you can’t remember this, just document what stimulation is necessary for arousal)
- Attention – counts the months backward, spells globe backward (a problem with attention means delirium, assuming no dementia)
- Orientation – year, month, date, situation
- LOCAL BRAIN FUNCTION
- Frontal – no kinetic apraxia (test rock, paper, scissor), no disinhibition (naming Fs)
- Memory – 5 minute recall (note whether memory jogging required)
- Language – Naming items nl, receptive and expressive language nl (can test visual comprehension with reading aloud). Test writing if you are unclear on aphasia vrs dysarthria.
- Constructional praxis – nl copy of cube, nl clock drawing
- Right inferior parietal lobe (+/- left): Double simultaneous stimulation – can check visual, tactile
- Left parietal: math (subtracting 7 from 100 serially)
References: Strub and Black’s The Mental Status Examination in Neurology