Mental state examination - AMTS, MMSE, frontal lobe testing

Question 1

What is the AMTS and its use?

Answer 1

Abbreviated mental test score (AMTS) is a 10-point assessment

Screens for both delirium and dementia, although further tests are necessary to confirm these diagnoses

Question 2

What are the AMTS questions?

Answer 2

1. Age
2. Time to nearest hour
3. Address to repeat - 42 West Street
4. DOB
5. Year
6. Name of place
7. Two people
8. WW1 begin
9. Monarch
10. Count 20-1

Question 3

What AMTS score indicates need for further assessment?

Answer 3

A score of 6 or less suggests delirium or dementia, although further tests are necessary to confirm the diagnosis.

Question 4

What are 3 assessments of cognition?

Answer 4

• Mini-mental state exam (MMSE)
• Abbreviated mental test score (AMTS)
• Addenbrooke’s cognitive examination III (ACE-III)

Question 5

What is a common use of the MMSE?

Answer 5

assess the progression of Alzheimer’s disease

Question 6

What scores on the MMSE suggest normal vs impaired cognition?

Answer 6

≥25 – Normal

21 – 24 – mild impairment

10 – 20 – moderate impairment

<10 – severe impairment

Question 7

What do the questions assess in the MMSE?

Answer 7

• Orientation to time
• Orientation to Place
• Registration
• Attention and Calculation
• Recall
• Language
• Repetition
• Following complex commands

Out of 30 points

Question 8

Answer 8

Question 9

Give 3 advantages of the MMSE.

Answer 9

• Relatively quick and easy to perform
• Requires no additional equipment
• Can provide a method of monitoring deterioration over time

Question 10

Give 3 disadvantages of the MMSE.

Answer 10

• Biased against people with poor education due to elements of language and mathematical testing
• Bias against visually impaired
• Limited examination of visuospatial cognitive ability
• Poor sensitivity at detected mild/early dementia
• Copyrighted and costs money

Question 11

What are the signs of frontal lobe syndrome?

Answer 11

Executive dysfunction

• Poor judgement
• Poor reasoning and problem-solving
• Poor planning and decision-making

Social behaviour and personality change

• Loss of social awareness: irresponsible/ disinhibited/ inappropriate behaviour
• Impulsivity
• Euphoric or ‘fatuous’ mood; lability
• Repetitive or compulsive behaviours

Apathy

• Lack of motivation and initiative
• Decline in self-care.

Depending on the part of the lobes most affected, people tend to be either apathetic or disinhibited, impulsive, aggressive, and socially inappropriate.

Question 12

What are 3 causes of damage to the frontal lobe?

Answer 12

• Dementia
• Stroke
• Head injury

Question 13

Frontal lobe testing (1)

Answer 13

Frontal lobe testing (2)

Question 14

Frontal lobe testing (3).

Question 15

What is the Luria test?

Answer 15

Assesses ability to shift from one action to another

Question 16

What does the no-go-tast involve and test?

Answer 16

Ability to inhibit an inappropriate response (i.e. here the patient has the urge to copy you, but has to inhibit this and do the opposite).

1. When I touch my nose, you raise your finger, like this. - Show patient: point to the ceiling with your right index finger.
2. And when I raise my finger, you touch your nose, like this - Show patient: touch your nose with your right index finger.

Question 17

Name two test for verbal fluency.

Answer 17

Tests for semantic memory (retrieval). Should score >15.

1. FAS testing - e.g. words beginning with F for a minute, no names allowed
2. Animals in a minute - alternative to FAS

Question 18

What tests are used for abstarct reasoning?

Answer 18

Proverbs e.g. people in glass houses shouldn’t throw stones. Ask about meaning of this. NB: don’t translate across cultures and different interpretation in ASD, ADHD, and schizophrenia.

Cognitive estimates e.g. how fast can a racehorse run? what is the best paid job in the country?

Question 19

What tests are used for primitive reflexes?

Answer 19

Frontal lobe should inhibit primitive reflexes but if damaged then they may reappear:

• Grasp reflex - ask to stroke patient’s palm towards thumb
• Suck/pout reflex - lightly tap patient’s lips or stroke down their philtrum
• Rooting reflex - stroke the patient’s cheek with finger