Mental Status Examination

Question 1

What are the components of a Mental Status Examination?

Answer 1

• Level of consciousness
• Cognition
• Attention
• Orientation
• Memory
• Language
• Perception

Question 2

What is the definition of alert in levels of consciousness?

Answer 2

Awake and attending; responds and is awake to conversations

Question 3

What does lethargic mean in levels of consciousness?

Answer 3

Lethargic:

• Drowsy, may fall asleep if not stimulated, difficulty focusing, loud voice needed.

Question 4

What is delirium often characterized by?

Answer 4

Confusion of the circumstances, may hallucinate or act as if in dream state; conversation may not make sense

Question 5

Define obtunded in levels of consciousness.

Answer 5

Confused, difficult to arouse, interactions with therapist highly unproductive

Question 6

What does stupor indicate?

Answer 6

Semi-coma, responds only to strong/noxious stimuli, unable to interact with the therapist

Question 7

What are the characteristics of a coma?

Answer 7

Deep coma, cannot be aroused by any stimulation, GCS score of less than 8

Question 8

What is a coma?

Answer 8

Complete loss of the arousal system, unable to be awakened with reflex and postural response motor function, no sleep/wake cycles.

Question 9

Define a vegetative state.

Answer 9

Loss of awareness to self and environment, sleep/wake cycles with motor function response to noxious stimuli only.

Question 10

What is a minimally conscious state?

Answer 10

Minimally Conscious State:

• Partial preservation of conscious awareness including inconsistent localized responses to noxious stimulation or sound, verbalization, purposeful behavior such as holding objects and visual pursuit.

Question 11

What is the Glasgow Coma Scale used for?

Answer 11

Glasgow Coma Scale:

• To monitor level of consciousness and coma in patients with brain injury, especially in acute care and trauma setting.

Question 12

What is the scoring ranges of the Glasgow Coma Scale?

minor, moderate, severe

Answer 12

Between 3-15

• Minor Brain injury = 13-15 points
• Moderate Brain injury 9-12 points
• Severe Brain injury = 3-8 points

Question 13

What does an initial GCS score of 3 indicate?

Answer 13

• Severe brain injury
• Mortality between 65-99%

Question 14

What does the Ranchos Los Amigos Levels of Cognitive Functioning (RLOCF) describe?

Answer 14

The cognitive and emotional behaviors of patients emerging from coma or minimally conscious state.

Question 15

What assistance is required for levels I-III III in RLOCF?

Answer 15

Total assistance

Question 16

What does levels IV-V in RLOCF require?

Answer 16

Maximal assistance

Question 17

What is required for level VI in RLOCF?

Answer 17

Moderate assistance

Question 18

What is needed for level VII in RLOCF?

Answer 18

Minimal assistance for routine tasks

Question 19

What does level VIII in RLOCF require?

Answer 19

Stand-by assistance

Question 20

What does A&O x4 stand for?

Answer 20

Alert and Oriented to…

• Person
• Place
• Time
• Situation

Question 21

What is selective attention?

Answer 21

Selective Attention:

• The ability to select important/relevant information while ignoring other sources of information.
• Ability of a patient to follow the therapist’s verbal cues while ignoring nearby conversation.

Question 23

What is divided attention?

Answer 23

Divided Attention:

• The ability to process more than one source of information or to perform more than one task at a time.
• Ability to talk while walking or to take money out of a wallet while walking.

Question 25

What is attention switching or alternating attention?

Answer 25

**Attention Switching** or **Alternating Attention**: * The ability to switch attention between two tasks or sources of information as needed for the task and environment. * Patient stops conversing to perform a difficult task, then resumes talking once complete.

Question 26

Give an example of attention switching.

Answer 26

Patient stops conversing to perform a difficult task, then resumes talking once complete.

Question 28

What is sustained attention also called?

Answer 28

Vigilance

Question 29

Where is sustained attention believed to be a function of?

Answer 29

The right hemisphere

Question 30

How is sustained attention tested?

Answer 30

By asking the patient to repeat numbers or tap a hand when a specific letter is heard.

Question 31

What is the Walking While Talking Test (WWTT)?

Answer 31

A test where the patient walks 20 feet, turns, and returns 20 feet while performing a simple talking task, then repeats with a more complex task.

Question 32

What does the WWTT test predict?

Answer 32

Falls in older adults

Question 33

What is the cut score for the simple talking test in WWTT?

Answer 33

20+ seconds

Question 34

What is the cut score for the complex talking test in WWTT?

Answer 34

33+ seconds

Question 35

What is the [Mini Mental Status Examination](https://cgatoolkit.ca/Uploads/ContentDocuments/MMSE.pdf) (MMSE)?

Answer 35

**Mini Mental Status Examination** (**MMSE**): * A standardized test for assessing cognitive function.

Question 36

What is the [Montreal Cognitive Assessment](https://www.sciencedirect.com/topics/medicine-and-dentistry/montreal-cognitive-assessment) (MoCA) **?** * Cutoff score = **?**

Answer 36

**Montreal Cognitive Assessment** (**MoCA**): * A cognitive test used to assess various cognitive abilities. ## Footnote * Cutoff score < 26

Question 37

What is the cutoff score for the MoCA?

Answer 37

<26

Question 39

What are the two types of memory associated with memory and learning **?**

Answer 39

**I**) **Explicit memory** (declarative memory): * Explicit memory include remembering a specific fact, a specific event, or the steps required to complete a task. **II**) **Implicit memory** (Procedural or Nondeclarative memory) * Memory for tasks or information performed without conscious thought, such as tying shoes. ## Footnote * Learning and memory can be of two types.

Question 41

What is short-term memory (STM)?

Answer 41

**Short-term memory** (STM / Recent Memory): * The capability to remember current day-to-day events and retrieve material after minutes, hours, or days.

Question 42

What is long-term memory (LTM)?

Answer 42

**Long-term memory** (LTM / Remote Memory): * The recall of facts or events that occurred years before.

Question 43

What are the standardized tests for screening depression?

Answer 43

I) **Geriatric Depression** Scale: * Scores of 0-4 are considered **normal** * 5-8 indicate **mild depressive** symptoms * 8-11 indicate **moderate depressive** symptoms * 12-15 indicate **severe depressive** symptoms II) **Beck Depression** Inventory: * “Feeling sad or depressed can cause you to think or even move differently This questionnaire looks at your overall mood and feelings. * Please answer YES or NO to each question even if the answer varies day to day. * Try to give the answer that BEST describes how you feel most of the time. * If you need help reading the questions, I can read them for you.”