Chapter 6 - Basic neurologic examination-mental status exam ～白

Neurological exam Neurological exam

Personal data Physical exam Subjective data Objective data
 Age, gender, height,  Mental state, motor  Are apparent only to  Are detectable by an
weight, history, chief examination, sensory the person affected and observer or can be
complaint … examination, cranial can be described or tested by using an
nerve examination, verified only by that accepted standard
functional assessment person  Signs
 Symptoms  I.e. BP, discoloration of
 I.e. pain, itching, and the skin
worrying
 Contents of neurological exam:
a) History
b) Mental state examination
c) Motor exam
- Strength and function of extremities, coordination, abnormal movement
d) Sensory exam
- Dermatomes, superficial / deep / combined cortical sensation
e) Cranial nerve exam
f) Functional assessment

 Mental status exam 智能状态评估：

Consciousness 意识状态
Orientation 定向力
Memory 记忆
Attention 注意力
Calculation 计算
Language 语言能力
Abstract thought 抽象思考
Visuoperceptual function 视知觉功能

 Consciousness 意识状态
¤ 描述病人意识觉醒的程度
I. Clear, alert
II. Drowsy, lethargy 昏沉想睡觉
III. Obtunded 不易叫醒且当醒着时会觉得困惑
IV. Semicoma, stupor 只会对强烈及有害的刺激有反应。当刺激停止时会回到无意识状态
V. Coma 不能被任何的刺激叫醒
¤ Glasgow Coma Scale (GCS)
1. Eye opening: 1～4
2. Motor response: 1～6
3. Verbal response: 1～5
 轻度昏迷 = 13～14 分；中度昏迷 = 9～12 分；中度昏迷 = 3～8 分
 Orientation 定向力
¤ 对于人、时、地的意识或理解
¤ Time:
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 Chapter 6 - Basic neurologic examination-mental status exam ～白
o What day is it? What is the date? What is the season? What is the time of day?
¤ Place:
o What is the name of the place we are in? What is the name of the ward/ hospital? What is
the name of the town/ city?
¤ Person:
o What is your name? What is your job? Where do you live?

 Memory 记忆
Immediate memory
- Ask him immediately to repeat it
back to you (immediate recall)
- Name and address test
o 以口头方式说出一连串数
字或物品名称，然后要求
病人立即重复上述项目
o Tell the patient that you
want him to remember a
name and a address
o Use the type of address
that the patient would be
familiar with
Short-term memory
- 可记得几分、几小时或几天前的
事
- About 5 minutes after asking the
patient to remember the name
and address ask him to repeat it
o The 5 minutes can be
spent testing calculation
and abstract thought
Long-term memory
- 几个月或几年前的事
- Test factual knowledge you would
expect the patient to have
o May vary from patient to
patient and you need to
tailor your questions
accordingly
o I.e. 生日、出生地、兄弟
姐妹人数、结婚日期 …

 Attention 注意力
¤ 注意力是能够执行一项任务而不被其他刺激所干扰
¤ 可借由倒退拼字或重复一长串数字而判断是否缺损
¤ Digit span test
顺念数字 (forward)
逆念数字 (backward)
 I.e. Tell the patient that you want him/ her to repeat some numbers that you give him. Then
explain that you want him/ her to repeat the numbers backwards
 正常人可说出逆念 5 个数字，顺念 7 个数字

 Calculation 计算
o Serial sevens
- Ask him to take seven from a hundred, then seven from what remains

 Language 语言能力
 Abnormalities of speech need to be considered first as these may interfere with history-taking and
subsequent ability to assess higher function and perform the rest of examination
Abnormalities of speech
Process Abnormality
Understanding thought and word finding Aphasia 失语症
A）Expressive aphasia: motor aphasia
B）Receptive aphasia: sensory aphasia
C）Global aphasia: both motor and sensory aphasia
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Chapter 6 - Basic neurologic examination-mental status exam ～白
 Absence of speech
 All disorders of understanding, thought and word finding
 Aphasia test:
Expressive language test 表达性语言
o 这叫什么、是什么颜色、有什么用？
Receptive language test 接受性语言
o 铅笔是哪一支、你用哪一只手吃饭、哪一支是
黄色的铅笔？

Voice production Dysphonia 发声困难

 A disturbance of voice production
 Disturbance of voice quality, pitch or intensity
 May reflect either local vocal cord pathology (I.e. laryngitis),
an abnormality of the nerve supply via the vagus nerve, or
occasionally a psychological disturbance

Articulation Dysarthria 构音困难

 Muscle control disturbance results in speech disorder
 Voice production requires coordination of breathing, vocal
cords, larynx, palate, tongue and lips
 Dysarthria can reflect difficulties at different levels

 Abstract thought 抽象思考

¤ Abstract thought tests for frontal lobe function
¤ Useful with frontal lobe lesions, dementia and psychiatric illness
¤ I.e. Tell the patient that you would like him to explain some proverbs to you

 Visuoperceptual function
o Visual and body perception
o Tests for parietal; and occipital lesions
 Are useful in dementia
Facial recognition: famous faces
- Ask the patient to identify the faces of famous people
- Prosopagnosia: does not recognize the face
Body perception
- Hemineglect: patient ignores one side (usually left) and unable to find his hand if asked