The Mental Status Examination in Adults

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The mental status examination in adults
Author: Po-Haong Lu, PsyD

Section Editor: Mario F Mendez, MD, PhD
Deputy Editor: Janet L Wilterdink, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Mar 2018. | This topic last updated: Jul 23, 2014.
INTRODUCTION — Despite the technological advances in neuroimaging, there is still no way of directly
observing cognitive function. Neuroscientists and clinicians continue to rely on the mental status or
neuropsychological examination for much of their knowledge of the state and functioning of the brain. The study
of the behavioral expression of brain dysfunction is the essence of mental status examination and
neuropsychological assessment, which is critical to diagnostic accuracy, patient care and treatment planning,
rehabilitation and treatment evaluation, and research.
Methods of examining cognition include:
● Bedside or clinic mental status testing. This is generally the initial assessment of cognition and mental status
and can be brief or more extensive depending on the setting and level of concern.
● Mental status scales. These are usually used as a screening tool but also as a baseline measure to follow
patients over time.
● Neuropsychological testing for extensive evaluation.
The goals of the mental status examination are to distinguish normal from abnormal cognition and dementia from
delirium or primary psychiatric disease. Bedside or clinic mental status testing is not standardized. Determination
of deficits versus strengths often depends on extrapolated norms from standardized neuropsychological tests.
Patterns of deficits in the mental status examination can sometimes allow a preliminary hypothesis as to the
underlying pathogenesis of a dementing process. The mental status examination also allows a measure of the
severity of a patient’s problems that can be followed over time.
This topic will review the mental status examination as performed at the patient's bedside or in an outpatient
office. The use of mental status scales and detailed neuropsychological testing are presented separately. Other
features of the neurologic examination are discussed separately. Other facets of the evaluation of patients with
cognitive disorders are also discussed separately. (See "The detailed neurologic examination in adults" and
"Evaluation of cognitive impairment and dementia".)
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CLINICAL INTERVIEW — The evaluation of mental status, whether in the office or at the bedside, begins with
direct questioning and careful observation of the patient during the course of the initial medical history-taking.
Many aspects of mental status and cognition can be assessed in this interview: attention, speed of responses,
and ability to answer questions and provide relevant information, as well as their overall appearance and degree
of cooperation. These observations, along with any specific complaints brought forward by the patient or family
member, can guide the examiner into performing a more or less detailed mental status examination.
The clinical history provides important information that is supplemental to the mental status examination. The
patient's age, educational level, and premorbid functioning are obviously relevant, as are medical history and
current medications. How the patient functions in his or her daily life as well as any changes in personality,
behavior, and interpersonal relationships with family and friends are important features to ask about. In this
regard, having an independent person to interview, preferably one who lives with the patient and/or has a long-
standing history with them, is invaluable.
The clinical interview also provides an opportunity to establish rapport with the patient and make him/her
comfortable. The collection of information that is relatively mundane and functional is less stressful than overt
testing of cognition. Performance in this setting may provide a less biased assessment than explicit testing,
which often contributes to test and performance anxiety.
MENTAL STATUS EXAMINATION — An assessment of mental status should specifically note deficits in the
following spheres:
● Level of consciousness (arousal)
● Attention and concentration
● Memory
● Language
● Visual spatial perception
● Executive functioning
● Mood and thought content
● Praxis
● Calculations
These spheres as categorized are somewhat arbitrary and overlapping, as are the tests used to evaluate them.
The following sections will outline some simple, and some relatively more detailed, tests of assessing these.
Whenever possible, it is optimal to conduct mental status examination and neuropsychological testing in a quiet
room, without distractions. This may be difficult in busy hospital or clinic settings.
Arousal — While taking the history and examining the patient, it is first important to observe whether the patient
is alert, attentive, sleepy, or unresponsive. An adequate state of arousal is a prerequisite for further mental status
testing. The evaluation of a patient in stupor or coma is discussed separately. (See "Stupor and coma in adults".)
Attention and concentration — Attention is the ability to focus and direct cognitive processes and to resist
distraction; concentration is the ability to focus and sustain attention over a period of time. Assessment of
attention is critical to the interpretation of other elements of the neurocognitive examination because patients
who are inattentive will exhibit disturbances in cognitive performance, particularly in memory and executive
function, thus confounding the interpretation of the contribution of specific cognitive failures.
Abnormal attention is often evident in the clinical interview; the patient may have difficulty concentrating, be
easily distracted by stimuli, lose his/her train of thought, and tend to ramble.
The most elementary assessment of attention is accomplished through the digit span test [1]. The examiner
recites number digits at the rate of one number per second and asks the patient to repeat back the number
sequence in exactly the same order. The string of digits increases in length. A normal span is seven digits plus or
minus two digits for adults, regardless of age or educational level [2]. Spelling simple words backward or stating
the months of the year in reverse are other simple tests of attention and concentration.
More complex tests of sustained attention also involve cognitive processing speed; time of performance is an
important component in these tasks. Examples include part A of the Trailmaking Test (Trails A) (figure 1) [3-7],
symbol-copying tasks (eg, Digit Symbol) (figure 2) [8,9] and letter-cancellation tasks (figure 3) [10,11]. While
these tests can be part of the office assessment, they are more typically administered in the setting of formal
neuropsychologic testing.
Prominent deficits in attention and concentration are typical in patients with toxic metabolic encephalopathy and
with acute psychiatric disorders, but are less conspicuous in early neurodegenerative disease. (See "Diagnosis
of delirium and confusional states" and "Acute toxic-metabolic encephalopathy in adults".)
Memory — Impaired memory is a common complaint which may be presented by patients and/or family
members. Memory has multiple dimensions.
● Immediate and working memory is assessed by tests of attention including the digit span [1]. (See 'Attention
and concentration' above.)
● Recent memory involves the learning of new material. Testing orientation to time and place and asking the
patient about events of the day are useful tools in the office or at the bedside to assess recent memory [1,2].
A more explicit test of recent memory, is asking patient to remember three to four words, having them repeat
them to ensure normal attention/immediate memory, and then ask them to recall the words after 5 to 10
minutes of distraction. For patients who are unable to recall the original words, category hints (eg, "animal")
or multiple-choice cues ("cow, horse, or dog") can be given to further assess the severity of the deficit.
Longer lists of 8 to 10 words can also be used to increase the sensitivity of the test. Normal older adults
should be able to remember three out of three words without cues and up to eight words with cues [2].
The "three-words three-shapes" memory test is another test of recent memory that can be useful in the
office setting [12]. In this test, patients are asked to copy three words (eg, justice, courage, thirst) along with
three abstract shapes. Delayed recall is tested in 5, 15, and 30 minutes with re-exposure to the stimuli as
needed. If recall is faulty, multiple-choice recognition is tested.
● Retrieval of remote memories can be tested by asking for the names of United States Presidents in reverse
order as far back as the patient can remember, or by asking about important historical events and dates as
well as sporting events and popular television shows [1,2]. The patient can also be asked about details of
personal life such as his or her birth date, the names and ages of children and grandchildren, and work
history, assuming independent verification is available.
Memory functions can also be separated into episodic memory (for specific events and contexts) versus
semantic memory (for vocabulary and concepts). These can be differentially affected by neurologic disease.
Semantic memory is assessed by asking the patient the meanings of words, phrases, and symbols. Bidirectional
naming tasks, in which the patient not only names an object but describes its use or function, is another
assessment tool.
Assessment of memory functions should include learning of visual as well as verbal information. Most bedside
assessments of memory employ verbal tasks. In the setting of neuropsychological testing, visual memory is
tested using simple and complex line figures (eg, Rey-Osterrieth complex figure) (figure 4) [9]. The patient is
required to construct the figure immediately after exposure and then to reproduce the design after a specified
time interval. Other visual memory tasks not involving a constructional component can include the use of
photographs; recalling events of a photograph shown to the patient can test recent memory, while remote
memory testing might employ photographs of famous individuals. However, failure to recognize familiar faces
can also be a visual perception problem, as discussed below.
Supraspan learning tasks involving a word list are used in the setting of neuropsychologic testing [13]. Learning
trials usually involve repetition of a list of 15 to 20 words over several trials to assess whether the patient exhibits
a learning curve. A second list is usually administered to serve as a distractor, followed by a short-delay recall
trial. Long-delay recall of the original words is typically administered after 20 to 30 minutes. The majority of list-
learning and memory tasks also involve a recognition memory format, in which target words are interspersed
with foils; patients are asked whether they remember hearing the word through "yes-no" multiple choice format or
circling the target words from either lists or stories.
Many patterns of memory loss may occur. Amnestic disorders are characterized by normal working and impaired
recent memory and imply mesial limbic and hippocampal dysfunction. This is a typical early deficit in individuals
with Alzheimer disease. (See "Clinical features and diagnosis of Alzheimer disease".) Patients with Korsakoff
psychosis can have even more profound loss of recent memory, which is often, but not always accompanied by
confabulation (fabricated material). Retrieval deficit syndromes are more typical of those with frontal-subcortical
circuit dysfunction.
Language — Assessment of language functions begins with listening to the patient's spontaneous speech
during the clinical interview. Written and oral language function is further assessed by formal testing and noting
deficits in the following domains:
● Fluency. This is usually assessed by listening to the patient's spontaneous speech.
● Content. Language errors during spontaneous or tested speech can include paraphasic errors and
neologisms.
● Repetition. Patients are asked to repeat phrases of increasing complexity. A common screening phrase
used is "no ifs, ands, or buts".
● Naming. Patients are typically asked to name real or pictorial objects presented to them, again usually
beginning with words more frequently used and progressing to those that are less common.
● Comprehension. Understanding of both written and oral language is evaluated by giving a sequence of
commands, beginning with one-step, midline commands ("Close your eyes") and progressing to multi-step
commands.
● Reading. Patients are asked to read aloud from a newspaper or from a list of single words.
● Writing. The patient is asked to write a sentence spontaneously.
Verbal fluency tasks ask patients to generate words within a specified length of time. While not specific for
language function, this test provides a means for rapid assessment of word knowledge and verbal executive
function. Patients may perform differently on category fluency tests (eg, lists of animals) and letter fluency test
(eg, lists of words beginning with F). Normal performance is age related, with at least 15 items expected after
one minute at age 65 years [14]. (See "Clinical features and diagnosis of Alzheimer disease", section on
'Cardinal symptoms'.) Cut-off scores of 12 for animals and 10 for F words are also commonly employed in clinic
settings.
Validated scales such as the Boston diagnostic aphasia examination and Western aphasia battery are often used
in clinical studies and as part of neuropsychologic test batteries; these are too time-consuming to administer in
the typical office setting [15-17].
A loss of ability to produce and/or understand written or spoken language is called aphasia. This may be an
isolated finding or may be one feature of a patient's cognitive impairment. In the former situation, the assessment
of language as described above is used to classify the aphasia according to one of the classic language
syndromes listed in the table (table 1).
The assessment of language function and the categorization of aphasias are discussed in detail separately. (See
"Approach to the patient with aphasia".)
Visual spatial perception — Problems with visual spatial perception are suggested by a history of losing
objects, getting lost, or difficulty navigating familiar or unfamiliar terrain. Patients may also exhibit frank
visuospatial neglect when they are observed by family and friends to ignore visual stimuli in one visual field
(usually the left) as when searching for objects in the refrigerator or ignoring half their plate at meal time.
Visuospatial functions encompass perceptual and constructional abilities, which are typically assessed through
copying/drawing and building/assembly tasks [2]. In the former, patients are asked to copy visual stimuli such as
a diamond, overlapping pentagons, a three-dimensional cube, or more complex designs (eg, Rey-Osterrieth
diagram) (figure 4) [8,9]. Line bisection and Letter Cancellation tests (figure 3) can be useful to elicit visuospatial
neglect [10,11].
Clock drawing is another sensitive tool for visual spatial problems but encompasses abilities from other cognitive
domains. Some recommend this single task as a screening tool for dementia.
Careful observation of abnormal spatial relationships, absence of detail, stimulus-boundedness, loss of three-
dimensional perspective, or neglect of one part of the drawing can help distinguish between perceptual failures,
spatial confusion, or apraxia.
The Block Design subtest of the Wechsler Adult Intelligence Scale, third edition (WAIS-III) is typically used as a
part of the neuropsychologic test battery and involves constructing blocks to match abstract designs [1]. While
deficits in drawing or assembly can co-occur, the two types of activities are more likely to be dissociative and can
help discriminate between spatial and visual aspects of a constructional disability, and estimate the relative
contribution of each.
Prominent problems with visual spatial tasks out of proportion to other cognitive deficits, particularly when
visuospatial neglect is elicited, suggest specific injury within the nondominant parietal lobe.
Praxis — Praxis, or more specifically, ideomotor praxis, refers to the performance of learned motor movements
in the absence of primary deficits in motor and spatial abilities [2,18]. Frank problems with ideomotor praxis may
be obvious when patient or family member reports difficulty dressing, feeding, and bathing that is not explained
by gross motor deficits.
On testing, ideomotor praxis is evaluated by asking the patient to perform increasingly complex motor tasks. As
an example, the patient may be asked to demonstrate the use of an object (eg, comb, hammer, fork) with and
without the actual object in hand. Difficulty with this type of task is often labeled ideomotor apraxia [1,18,19]. A
step-wise series of coordinated tasks "take this piece of paper, fold it in half, and place it in the envelope" is
another way to demonstrate praxis, in this case, ideational praxis, which refers to the capacity to carry out a
sequential set of actions toward a final goal.
A significant language disorder or motor deficit can affect the ability to assess praxis. Common errors include
using the wrong object or body part to perform a task. Many patients who cannot perform motor tasks to
command can do so spontaneously or by imitation.
Patients with neurodegenerative disease may also have difficultly performing a series of coordinated tasks. More
specific or isolated problems with praxis suggest involvement of the dominant parietal lobe [19]. Ideomotor
apraxia is a relatively prominent feature of corticobasal degeneration [18]. (See "Corticobasal degeneration",
section on 'Cortical dysfunction'.)
Calculations — Simple mathematical problems are given to the patient to assess their ability to perform
calculations. These include adding a series of coins, and performing "serial sevens" (sequentially subtract 7,
beginning with 100). Calculation testing is sensitive to impaired attention and performance (test) anxiety as well
as to the patient's educational level.
Acalculia is the inability to perform mathematical calculations. There are many forms of acalculias, the most
specific of which is associated with left angular gyrus lesions. Acalculia is also a feature of neurodegenerative
dementia occurring along with other cognitive deficits.
Executive functioning — Executive functioning is a complex set of capacities including volition, planning,
purposive action, and effective performance that enable a person to engage successfully in appropriate, goal-
directed, socially responsible, and self-serving behavior [4]. The prefrontal cortex and their connections through
the caudate nuclei are the main source of executive functions.
An overview of executive function is obtained in the history, in which patients and family members may be asked
about function in everyday life and with which tasks they may require help or direction. Impairments in insight
and judgment are early indicators of executive dysfunction; these are also better assessed in the clinical history
(eg, "what problems do you think you are having?"; how would you handle [eg, minor household emergencies]?)
rather than by a specific test.
Evaluation of executive functions is difficult; formal neuropsychological assessment of this domain is usually
broadly divided into five types of mental tasks [20]:
● Working memory is the ability to temporarily hold information in mind and manipulate the information in
order to carry out complex cognitive tasks. It is often tested with serial reversal tasks (eg, digits backwards)
or sequencing of mixed numbers and/or letters of alphabet in ascending order.
● The ability to divide attention and ability to change sets (ie, mental flexibility). Examples include the
Trailmaking Test, part B (figure 1) and the Wisconsin Card Sorting Test (figure 5) [3,20,21].
● Generative ideation through measures of verbal and design fluency [20]. Verbal fluency tasks are described
above. (See 'Language' above.) Analogously, design fluency tests assess the ability of the patient to
generate novel designs within a defined time period.
● Motor programming. Tests of motor programming include asking the patient to imitate simple rhythms (eg,
clap, clap, tap, knock) or to copy a sequence of m's and n's [1,2,20]. Another example is the Luria "fist-edge-
palm" test, in which the patient is asked to tap that aspect of their hand to the desk in repeated sequences
[20]. Impaired patients typically demonstrate perseveration, which refers to the phenomenon of being “stuck-
in-set” and continuing elements of previous actions into the present activity.
● The ability to inhibit responses. This can be tested by "go/no go" tests [2,20]. As an example, the patient is
asked to "tap when I tap once" and to "not tap when I tap twice". Another test of this function is the Stroop
Color-Word Interference (figure 6) [20,22].
Abstract reasoning is a related executive function and usually assessed by asking the patient to interpret
similarities and differences (eg, between word pairs such as watch-ruler, child-midget), idioms (eg, warm-
hearted), and proverbs (eg, "a rolling stone gathers no moss") [1,20].
Mood and thought content — Mood and emotional state have a strong impact on mental status and cognitive
functioning. Patients and family should be questioned about mood and outlook. The patient's affect (ie, the
outward expression of their mood) should be noted. Depression can present with cognitive impairment and is
suggested by a withdrawn affect that can include poor eye contact, tearfulness, and/or blunting. Apathy can be
difficult to distinguish from depression. Mood and affect can be incongruent in the case of pseudobulbar palsy
where tearfulness/laughing is disproportionate to the underlying feeling, and in brain injury or multiple sclerosis
where euphoria in some cases covers up clinical depression [2].
The patient's thought content as expressed through the patient's spontaneous speech in the clinical interview
and examination should also be assessed. Any abnormal intrusions, preoccupations, perseverations, delusions,
or hallucinations should be noted as these are vital to understanding the underlying process. If the patient is
poorly communicative it is often worthwhile to specifically elicit such a history of abnormal thoughts, by asking
the patient and/or family members about these symptoms.
In the setting of neuropsychological testing, the examiner may employ symptom checklists and other survey
instruments to elicit difficulties with mood, abnormal thought processes, and other relevant symptoms that may
impact test performance and interpretation:
● Minnesota Multiphasic Personality Inventory
● Beck Depression Inventory
● Geriatric Depression Scale
● Neuropsychiatric Inventory
Others — While not routinely assessed, the examiner may wish to test for right-left orientation and finger
agnosia, both features of the Gerstmann syndrome which includes dysgraphia and acalculia and localizes to
lesions in the posterior left hemisphere. Right-left orientation may be tested by asking the patient to point to or
move body parts on the right or left side. Finger agnosia is tested by asking patient to point to or manipulate
named fingers.
BRIEF COGNITIVE ASSESSMENTS — As previously discussed, a clinical interview in the office can provide an
adequate screening of mental status in many, if not most, individuals.
Over the course of long-term follow-up, when prolonged interviews are not routinely part of a brief scheduled
office visit, clinicians caring for the elderly often use brief cognitive assessments to screen for cognitive decline
and dementia.
● The mini-mental state examination (MMSE) is popular and well known. This tool is assessed on a scale of 0
to 30. The included items cover most cognitive domains, particularly those abilities most relevant to
dementia of the Alzheimer’s type (AD). The MMSE can be performed in a relatively short time interval (5 to
10 minutes).
● Clock drawing has also become popular as a screening tool for cognitive problems as a single task that
covers multiple cognitive domains.
These and other brief cognitive assessments are discussed in detail separately.
SUMMARY — A thorough mental status assessment is arguably more important in the diagnosis and
management of central nervous system syndromes, particularly dementing disorders, than any other procedure
or laboratory tests, including neuroimaging.
● The mental status examination, performed at the bedside or outpatient office, provides an initial assessment
of cognition and mental status and can be brief or more extensive depending on the setting and level of
concern.
● The mental status examination can generally distinguish those with normal versus abnormal cognition, and
also dementia from delirium or primary psychiatric disease. Determination of severity of deficits and
documentation of relative strengths with respect to age and education requires extrapolated norms from
standardized neuropsychological testing. Patterns of deficits in the mental status examination can
sometimes allow a preliminary hypothesis as to the underlying pathogenesis of a dementing process. The
mental status examination also allows a measure of the severity of a patient's problems that can be followed
over time.
● A thorough evaluation of mental status notes competency and/or deficits in the following cognitive spheres:
• Attention and concentration
• Memory
• Language
• Visual spatial perception
• Praxis
• Calculations
• Executive functioning
• Mood and thought content
Specific tests that provide an assessment of these functions are suggested in individual sections above.
Mental status testing is hierarchical; problems with arousal impede attention, which in turn impedes language
and memory and so forth. Furthermore, each test can be affected by multiple cognitive domains. As an example,
digit symbol assesses not only attention and information processing speed, but also visual scanning, memory,
graphomotor tracking, etc. It is not to interpret individual tests in isolation but to sample at least two tests in each
of the mental status areas. (See 'Mental status examination' above.)
● An initial screening assessment of mental status is usually provided during the clinical interview. (See
'Clinical interview' above.)
● For patient settings in which an extended interview is not performed, brief cognitive assessments are
suggested as a useful tool to screen for cognitive decline and dementia. (See 'Brief cognitive assessments'
above.)
● Neuropsychological testing can be of added value by providing a more precise measure of a patient's
cognitive strengths and weaknesses and assisting in differential diagnosis.
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Topic 14067 Version 3.0
GRAPHICS
Trails test (B version)
Trail-making tests assess visual attention.

In the "A version" of the test, the subject connects 25 consecutive targets -
each numbered (1, 2, 3, etc).
In the "B version" of the test, shown here, the subject alternates between
numbers and letters (1, A, 2, B, 3, C, etc).
The test is scored in speed and accuracy.
Reproduced with permission from: Schiffer RB, Lajara-Nanson WA. Neuropsychiatric

examination. In: Neuropsychiatry, 2nd ed, Schiffer RB, Rao SM, Fogel BS (Eds),
Lippincott Williams & Wilkins, Philadelphia 2003. Copyright © 2003 Lippincott
Williams & Wilkins. www.lww.com.
Graphic 66230 Version 8.0
Digit symbol test
In digit symbol tests, subjects are provided nine digit symbol pairs (top) and are then
asked to write the correct symbol for a series of digits (below). The test is scored based
on speed and accuracy.
Letter cancellation test
The Letter Cancellation Test is used to evaluate the presence, pattern, and severity of
visual scanning deficits. In this example, the patient correctly crossed out all instances
of the letter A.
Rey-Osterrieth complex figure
Subjects are asked to draw this diagram, first as a copy, then from memory.
Reproduced with permission from: Schiffer RB, Lajara-Nanson WA. Neuropsychiatric examination.
In: Neuropsychiatry, 2nd ed, Schiffer RB, Rao SM, Fogel BS (Eds), Lippincott Williams & Wilkins,
Philadelphia 2003. Copyright © 2003 Lippincott Williams & Wilkins. www.lww.com.
Aphasia syndromes
Wernicke-
Syndrome Flu Rep Comp Read Write Localization Lichtheim
model
Broca's - - + + - "Broca's" area- left inferior frontal, 1

often anterior MCA branch occlusion
Wernicke's + - - - - "Wernicke's" area- left superior 8

temporal and inferior parietal region,
often posterior MCA branch occlusion
Anomic + + + ± ± Temporal, parietal, and occipital 6

regions of cortex outside of classical
language areas
Conduction + - + + ± Superior temporal gyrus, inferior 5

parietal region adjacent to temporal
lobe; classically in arcuate fasciculus
Transcortical - + + + - Left mesial frontal, especially 4

motor supplementary motor area; anterior
cerebral artery occlusion
Transcortical + + - - - Left posterior watershed zone 7

sensory between MCA and PCA territories
Transcortical - + - - - Anterior and posterior watershed 4,7

mixed zones, effectively disconnecting
perisylvian cortex from other cortical
regions
Global - - - - - Large MCA or left carotid inclusions 4,5,7

infarcting a vast region of the left
hemisphere
Pure word + + - + + Left or bilateral superior temporal 10

deafness gyrus lesions
Pure alexia + + + - + Left occipital lobe with involvement 9

of splenium of corpus callosum
Aphemia - + + + + Motor cortex outflow to articulators 2
Pure + + + + - Left inferior frontal region 3

agraphia
Language disorders acquired through brain injury. The first eight rows are aphasic syndromes. Numbers in the
column labeled 'Wernicke-Lichtheim model' refer to lesion labels on Figure 1.
Flu: fluency; Rep: repetition; Comp: comprehension; Read: reading; Write: writing; +: relatively spared; -: impaired;
ACA: anterior cerebral artery; MCA: middle cerebral artery; PCA: posterior cerebral artery.
Data from: Mendez, MF, Clark, DG. Neuropsychiatric aspects of aphasia and related disorders. In: The American
Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences, 5th ed, Yudofsky, SC, Hales, RH
(Eds), American Psychiatric Publishing, Washington, DC 2007. p.522.
Wisconsin card sort test
The Wisconsin Card Sorting Test assesses the ability to divide attention and to change
sets.
The cards have different number, color, and type of shape on the face. A number of cards
(in this example, four) are presented to the subject. The test administrator decides, but
does not tell the subject, whether subsequent cards are to be matched based on number,
color, or shape. The subject is asked to make a match and then is told whether the match
was right or wrong. In subsequent attempts, the matching rule is learned. During the
test, the rules are changed and the subject adapts. The time taken for the patient to
learn the new rules are analysed to arrive at a test score.
Originally performed with a physical deck of cards, the test is now most commonly
carried out and scored by computer.
Stroop test
The Stroop Color Word Interference Test examines the ability to direct
attention. After first confirming that the subject can appropriately read the color
names and name the colors (top two panels), he/she is asked to name the color
of the ink that the word is printed in (third panel). As an example, the patient
should say for the first row of the third panel "Blue, Green, Blue, Blue, Red,
Green." The test is scored based on speed and accuracy.

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The mental status examination in adults - UpToDate 4/3/18, 7)13 PM

Official reprint from UpToDate®

Author: Po-Haong Lu, PsyD

Methods of examining cognition include:

● Neuropsychological testing for extensive evaluation.

● Level of consciousness (arousal)

● Attention and concentration

● Visual spatial perception

● Mood and thought content

needed. If recall is faulty, multiple-choice recognition is tested.

● Fluency. This is usually assessed by listening to the patient's spontaneous speech.

● Writing. The patient is asked to write a sentence spontaneously.

● Minnesota Multiphasic Personality Inventory

● Beck Depression Inventory

● Geriatric Depression Scale

• Attention and concentration

• Visual spatial perception

• Mood and thought content

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Topic 14067 Version 3.0

Trails test (B version)

Trail-making tests assess visual attention.

Reproduced with permission from: Schiffer RB, Lajara-Nanson WA. Neuropsychiatric

Graphic 66230 Version 8.0

Digit symbol test

Graphic 74553 Version 1.0

Letter cancellation test

Graphic 63183 Version 1.0

Rey-Osterrieth complex figure

Graphic 53426 Version 8.0

Broca's - - + + - "Broca's" area- left inferior frontal, 1

Wernicke's + - - - - "Wernicke's" area- left superior 8

Anomic + + + ± ± Temporal, parietal, and occipital 6

Conduction + - + + ± Superior temporal gyrus, inferior 5

Transcortical - + + + - Left mesial frontal, especially 4

Transcortical + + - - - Left posterior watershed zone 7

Transcortical - + - - - Anterior and posterior watershed 4,7

Global - - - - - Large MCA or left carotid inclusions 4,5,7

Pure word + + - + + Left or bilateral superior temporal 10

Pure alexia + + + - + Left occipital lobe with involvement 9

Aphemia - + + + + Motor cortex outflow to articulators 2

Pure + + + + - Left inferior frontal region 3

Graphic 72780 Version 1.0

Wisconsin card sort test

Graphic 50407 Version 1.0

Graphic 72016 Version 1.0

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