Mental Status Exam (MSE) Flashcards
Mental Status Exam (MSE)
Mental Status Exam (MSE)
Testing various components of one’s mental apparatus individually (as damage can be very discrete and one singular component of cognition can be affected only in some cases.)
Mental Status Exam (MSE)
What is tested during the MSE?
- Attention and orientation
- Language
- Memory
- Visuospatial function
- Executive functions
Mental Status Exam (MSE)
Attention and Orientation
How do we test it and why first?
- We test attention first because an attention problem may affect all other tests, same with orientation
- Counting backwards and forwards
- Asking people to raise their hand
- Asking people what day it is, who they are and where they are
Mental Status Exam (MSE)
What type of brain damage would affect attention and orientation?
Attention: Lesions in the cortical areas/cortex (telencephalon). Less likely to be related to the subcortical areas (like hippocampus) but is possible.
Orientation: Brain volume is reducing/higher CSF, cortex is thinning out
Mental Status Exam (MSE)
Contralateral Neglect
Hemi Neglect, Left Neglect
Failure to attend to the left side of the world (the patient’s left/egocentric left). There is no sensory impairment, it is not typical for them to have perceptual impairment either. Rather, it’s an attentional problem, an inability to direct attention to left part of their world. They cannot orientate themselves to the left side of the world.
Some people realize this is happening, some people have no awareness (anosognosia)
Mental Status Exam (MSE)
Testing Contralateral Neglect
Drawing Tests: Ask them to draw a clock or a house
House: Only draw right side of house (may draw a tiny bit of the left)
Clock drawing test: Numbers are all on right side of the clock
Anosognosia
A failure of an individual to self-reflect that they have a disorder. I.e. A lack of self of awareness
Real! People are genuinely unaware. Usually goes away in a few months.
Found in: Schizophrenia, TBI, contralateral neglect, stroke (paralysis is something they are not aware of)
Mental Status Exam (MSE)
What part of the brain would be damaged in contralateral neglect?
Right hemisphere (specifically parietal lobe)
Mental Status Exam (MSE)
Fluency
And remember ‘subsections’
How well can you speak? Do you skip words, can you spit out full sentences “normally?”
Naming - Being able to name items
Repetition - Can you repeat what someone says?
Prosody - Intonation that impacts meaning
Comprehension - Can they answer a question you ask?
Reading and Writing
Praxis - Being able to carry out a verbal request (sometimes people’s spontaneous behaviour is fine but they cannot perform motor aspects on command - apraxia)
Mental Status Exam (MSE)
Aphasia
A language problem.
Mostly related to left-hemisphere
Everyone with aphasia looks a little bit different.
Mental Status Exam (MSE)
Fluent Aphasia, A.K.A [Answer] Aphasia
Know about the area it’s in too!
Receptive Aphasia - Trouble with receiving language
You can produce large amounts of speech easily, but the words you speak do not make sense (“word salad”). Wernicke’s area is next to the auditory cortex. Is primarily an auditory region helping you comprehend speech. When it is damaged you cannot understand what others (or yourself)! are saying.
Mnemonic: WERnicke - because you can still say WORDS.
Mental Status Exam (MSE)
Non-Fluent, A.K.A [Answer] Aphasia
Global Aphasia is also non-fluent aphasia but not the one being discussed in this card.
Expressive Aphasia - Trouble speaking/expressing words.
They can understand what you are saying, but have trouble responding - key word responses with nouns and verbs.
Broca’s area is next to the precentral gyrus (both motor structures) and key in speech production.
Mnemonic: BROCA, because you have BROKEN speech.
Mental Status Exam (MSE)
Global Aphasia
Causes both speech production and comprehension issues. Falls within the non-fluent aphasia category.
Can be from focal or diffuse damage
Alexia
Dysfunction with reading after injury to the brain.
Agraphia
Dysfunction with writing after injury to the brain.
Where is damage to language?
Left hemisphere - Broca’s and Wernicke’s area, also, white matter damage can cause issues sometimes!
What part of the brain is important for implicit memory?
I.e. Motor tasks that we have repeated so many times they become automatic
Basal ganglia
Mental Status Exam (MSE): Memory
Testing short-term memory
Give 1-2 examples
Digit Span Test: Ask someone to memorize 5-9 numbers (working capacity for total units)
Pointing Span Test: Patient has to point to the same things in same order as shown to them
Mental Status Exam (MSE)
Damage to the medial temporal lobe, basal forebrain, thalamus, (sometimes prefrontal cortex), etc. is all relevant to this function within the brain:
Memory
Mental Status Exam (MSE): Attention/Memory
Testing visuospatial memory and attention
Line Cancellation Test: Draw a perpendicular line through every line you see (can reveal contralateral neglect)
Geometric Design Copying: Copying a shape like a cube
Are lines parallel, etc.
Perceptual Impairment: What is an object
Agnosia
A type of perceptual impairment.
Prosopagnosia
And location
A person cannot perceive faces normally/cannot take all individual features and put them into a perceptual whole.
Location: Ventral temporal lobe, fusiform gyrus
There are two streams of visual perception.
Mental Status Exam (MSE): Executive Function
Testing judgement
Using an unambiguous scenario: E.g. Asking a person what they would do with an envelope if they saw it on the side of the road (Answer: Put it in the mailbox)
Mental Status Exam (MSE): Executive Function
Testing verbal fluency
Listing: Ask people to list colours, countries, words, etc.
Mental Status Exam (MSE): Executive Function
Testing flexibility: Luria 3-Step Task
Ask person to put their hand down in a fist-edge-palm pattern - See if the patient is flexible enough to change the patterns over and over again.
If they are inflexible and unable to shift movements/keep repeating the same behaviour, that is perseverative movement.
Other test options for flexibility include asking a person to draw a loop/figure eight and see if they continue the task even after being told to stop.
Flexibility: Trail Making Test
Alphabet number alternation test–see if a person can go “A1B2C3…” for the whole alphabet. Requires tremendous cognitive flexibility.
Executive function is a component of the [part of brain].
Prefrontal Cortex (PFC).
