Mental Status Examination

Almost everyone is familiar with the idea of going to the doctor for a physical examination for school, employment, a driver's license, or for summer camp. Such an examination includes measurement of pulse and blood pressure, listening to the heart and lungs through a stethoscope, tapping tendons to elicit neurological reflexes, and so on. Everyone may not be aware, however, that the doctor is also making an assessment of mental status. Put simply, in order to assess the patient as a whole person, doctors determine not just how the heart and the lungs are working, but also how the brain is working.

For all organ systems (e.g., cardiovascular, respiratory, neurological) the assessment includes two components. The first part, the history, takes place when the doctor asks the patient about any symptoms or problems that may have been experienced subjectively. The second part, the examination, consists of objective observations that the doctor makes. For example, a patient may report heart palpitations, and the doctor may observe that the patient's pulse is rapid. Similarly, the patient may complain of having difficulty remembering, and the doctor may observe that the patient is repeating himself or herself during the conversation. The doctor may also perform a brief memory test as part of the mental status examination.

A mental status examination comprises a number of components. Orientation refers to the person knowing where he or she is (the location and address), what the date is, and so on. Attention refers to the person being able to concentrate on a mental task, such as doing a series of simple subtractions. Registration is the ability to listen and repeat back (showing that one has learned) a few words; recall is the ability to remember those words a few minutes later. The doctor may also ask the patient to name some familiar objects or write a simple sentence, to test language functions. The patient may be asked to copy a simple diagram, or draw a familiar object, to test constructional or visuospatial functions. The patient may also be asked to explain the meaning of a common phrase or proverb, or to explain the difference between two different objects or concepts, to test abstract thinking. The above are all examples of different cognitive functions that make up one's day-to-day intellectual functioning. They are not trick questions, and while they are not especially hard, they are designed to challenge patients sufficiently for the doctor to determine where potential problems may lie. Quite often, the end result of the examination is that the doctor can reassure the patient that his or her mental status seems normal. Or, for example, a memory problem may be present, possibly caused by depression, a stroke, Alzheimer's disease, or thyroid disease. One must first recognize the problem before one can identify the cause and recommend the appropriate treatment. Thus, the mental status examination is an important and essential part of the overall health assessment, and should be performed routinely.