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MENTAL STATUS

THOUGHT AND PERCEPTIONS


COGNITIVE FUNCTION
HIGHER COGNITIVE FUNCTION
THOUGHT AND PERCEPTIONS
Thought Process
Assess the logic, relevance, organization, and coherence
of the patient's thought processes as revealed in the
patient's words and speech throughout the interview
Does speech progress in a logical manner toward a goal?
Here you are using the patients speech as a window into
the patients mind.
THOUGHT AND PERCEPTIONS
Thought Content
You should assess information relevant to thought
content during the interview.
Follow appropriate leads as they occur rather than using
stereotyped lists of specific questions.
ex, You mentioned a few minutes ago that a neighbour
was responsible for your entire illness. Can you tell me
more about that? Or, in another situation, What do you
think about at times like these?
PERCEPTION
Process of using the senses to acquire information about the
surrounding environment or situation
PERCEPTION
Illusions may occur in grief reactions, delirium, acute and
posttraumatic stress disorders, and schizophrenia.
Hallucinations may occur in delirium, dementia (less
commonly), posttraumatic stress disorder, schizophrenia,
and alcoholism.
COGNITIVE FUNCTIONS
Orientation
By skillful questioning you can often determine the patients
orientation in the context of the interview.
Ex, , you can ask quite naturally for specific dates and times
COGNITIVE FUNCTIONS
Attention
Digit Span
Explain that you would like to test the patients ability
to concentrate
Recite a series of digits, starting with two at a time and

speaking each number clearly at a rate of about one


per second. Ask the patient to repeat the numbers
back to you
COGNITIVE FUNCTIONS
Attention
Serial 7s.
Instruct the patient, Starting from a hundred, subtract
7, and keep subtracting 7. . . .
Note the effort required and the speed and ac- curacy

of the responses.
Spelling Backward.
This can substitute for serial 7s. Say a five-letter word,

spell it, e.g., W-O-R-L-D, and ask the patient to spell it


backward.
COGNITIVE FUNCTIONS
Remote Memory
Inquire about birthdays, anniversaries, social security
number, names of schools attended, jobs held, or past
historical events such as wars relevant to the patients
past.
COGNITIVE FUNCTIONS
Recent Memory
These might include the days weather, todays appoint-
ment time, and medications or laboratory tests taken
during the day.
COGNITIVE FUNCTIONS
New Learning Ability
Give the patient three or four words such as 83 Water
Street and blue, or table, flower, green, and
hamburger.
Ask the patient to repeat them so that you know that the
information has been heard and registered.
HIGHER COGNITIVE FUNCTIONS
Information and Vocabulary
Note the persons grasp of information, the complexity of
the ideas expressed, and the vocabulary used.
If considered in the context of cultural and educational
background, information and vocabulary are fairly good
indicators of intelligence.
They are relatively unaffected by any but the most
severe psychiatric disorders, and may be helpful for
distinguishing mentally retarded adults (whose
information and vocabulary are limited) from those
with mild or moderate dementia (whose information
and vocabulary are fairly well preserved).
HIGHER COGNITIVE FUNCTIONS
Calculating Ability
Test the patients ability to do arithmetical calculations,
starting at the rote level with simple addition and
multiplication
Poor performance may be a useful sign of dementia or
may accompany aphasia, but it must be assessed in
terms of the patients intelligence and education.
HIGHER COGNITIVE FUNCTIONS
Abstract Thinking
The capacity to think abstractly can be tested in two
ways.
Proverbs
Ask the patient what people mean when they use some

of the following proverbs:


A stitch in time saves nine.

Dont count your chickens before theyre hatched.

The proof of the pudding is in the eating.

Note the relevance of the answers and their degree of

concreteness or abstractness.
HIGHER COGNITIVE FUNCTIONS
Abstract Thinking
Similarities
Ask the patient to tell you how the following are alike:
An orange and an apple

A church and a theater

A cat and a mouse

A piano and a violin

A child and a dwarf

Wood and coal


HIGHER COGNITIVE FUNCTIONS
Constructional Ability
The task here is to copy figures of increasing complexity
onto a piece of blank unlined paper.
Show each figure one at a time and ask the patient to
copy it as well as possible.
MMSE
Mini-Mental State Examination (MMSE) help to confirm the
presence of cognitive impairment
MMSE, an easily administered 30-point test of cognitive
function, contains tests of orientation, working memory
(e.g., spell world backwards), episodic memory (orientation
and recall), language comprehension, naming, and copying.