NEUROLOGICAL ASSESSMENT important for visual-spatial function.

The

Mental Status Exam dominant parietal lobe is important for

Anatomy praxis, which is the formation of the idea of

 Frontal lobes are important for attention, a complex purposeful motor act while the

executive function, motivation, and frontal lobes are important for the execution

behavior. Tests for frontal lobe function of the act. The Gerstmann syndrome, which

include working memory (digit span, consists of the constellation of acalculia,

spelling backward), judgement, fund of finger agnosia, right-left confusion and

knowledge, task organization and set agraphia, occurs with damage to the

generation such as naming lists of things in dominant inferior parietal lobe. Clinical

a certain category. tests include tests for agnosia (such as

inability to identify objects by tactile

 Temporal lobes are important for emotional exploration), apraxia (inability to perform

response (amygdala and its connections to purposeful motor acts on command),

the hypothalamus and frontal lobes) and constructional apraxia (inability to draw

memory (hippocampus and limbic objects which require use of visual spatial

connections). Clinically the main tests for organization) and testing for elements of

temporal lobe function are those of Gertsmann’s syndrome.

memory, particularly declarative memory.

 Occipital lobes are important for perception

 The principle area for receptive language is of visual information. Areas in the inferior

Wernicke’s area, which is located in the temporal visual association cortex are

posterior part of the superior temporal important for recognition of color and shape

gyrus of the dominant temporal lobe. The as well as the recognition of faces.

major region for expressive language is Projections from the occipital lobe to the

Broca’s area located in posterior part of the superior temporal-perietal area are

inferior frontal gyrus of the dominant important for perceiving motion of objects.

hemisphere. Homologous regions of the Tests that are used include visual fields,

non-dominant hemisphere are important naming of objects, naming of colors and

for the non-verbal contextual and emotional recognition of faces.

aspects as well as the prosody (rhythm) of

language. Tests for written and spoken  Traps

receptive and expressive language are used 1. there is more variability to the expression of

to “view” these language centers. lesions of the cerebral cortex than of structures more
caudal in the neuroaxis.

 Parietal lobes are important for perception 2. Time of day, stress, fatigue, and pain can affects a

and interpretation of sensory information patient’s performance on the mental status exam.

especially somatosensory information. The 3. You need to consider the patient’s social and

non-dominant parietal lobe is particularly educational background when evaluating the results
of the mental status exam.

 Pearls
1. The men tal status exam begins with listening and
watching the patient during the history part of the
examination.
2. The patient must be awake and alert in order to
have a “window” to view the cortex. So assessment of
the level of alertness and the intactness of the
reticular activating system is actually the first step in
the mental status exam.
Normal Exam
Orientation, Memory
 Asking questions about month, date, day of
week and place tests orientation, which
involves not only memory but also attention
and language. Three - word recall tests
recent memory for which the temporal lobe
is important. Remote memory tasks such as
naming Presidents, tests not only the
temporal lobes but also heteromodal
association cortices.
Attention-working memory
 Digit span, spelling backwards and naming
months of the year backward test attention
and working memory which are frontal lobe
functions.
Judgement-abstract reasoning
 These frontal lobe functions can be tested
using problem solving, verbal similarities
and proverbs.
Set generation
 Is a test of verbal fluency and the ability to
generate a set of items which are frontal
lobe functions. Most individuals can give 10
or more words in a minute.
Receptive language
 Asking the patient to follow commands
demonstrate that they understand the
meaning of what they have heard or read. It
is important to test reception of both
spoken and written language.
Expressive language
 In assessing expressive language it is
important to note fluency and correctness of
content and grammar. This can be
accomplished by tasks that require
spontaneous speech and writing, naming
objects, repetition of sentences, and reading
comprehension.
Praxis
 The patient is asked to perform skilled
motor tasks without any nonverbal
prompting. Skills tested for should involve
the face then the limbs. In order to test for
praxis the patient must have normal
comprehension and intact voluntary
movemnet. Apraxia is typically seen in
lesions of the dominant inferior parietal
lobe.
Gnosis
 The ability to recognize objects perceived by
the senses especially somatosensory
sensation. Having the patient (with their
eyes closed) identify objects placed in their
hand (stereognosis) and numbers written
on their hand (graphesthesia) tests
parietal lobe sensory perception.
Dominant parietal lobe function
 Right-left orientation, naming fingers, and
calculations.
Non - dominant parietal lobe function
 Is important for visual spatial sensory tasks
such as attending to the contralateral side of
the body and space as well as constructional
tasks such as drawing a face, clock or
geometric figures.
Visual recognition
 Recognition of colors and faces tests visual
association cortex (inferior occiptotemporal
area). Achromatopsia (inability to
distinguish colors), visual agnosia
(inability to name or point to a color) and
prosopagnosia (inability to identify a
familiar face) result from lesions in this
area.