The Mental Status Examination in Neurology

Strub, Richard L.; Black, F. William

doi:10.1097/00002093-199500940-00013

Cited by 138 publications

(31 citation statements)

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“…Further, some of the earlier instruments which were used to assess the severity and phenomenology of delirium did not assess the cognitive functions comprehensively; these instruments were useful as supplements for assessment of cognitive functions in patients of delirium. These include MMSE [35] , CTD [36,37] , Clock Drawing Test [38] , Digit Span Test [39,40] , Vigilance "A" test [40] , Mental State Questionnaire (MSQ) [41,42] and Short Portable Mental Status Questionnaire [43] . Delirium is more common in elderly, some of whom also suffer from dementia, hence it is also important to have an understanding of baseline cognitive functions of patients before considering the cognitive disturbances as part of the delirium.…”

Section: Instruments For Assessment Of Cognitive Symptoms Of Deliriummentioning

confidence: 99%

Assessment scales for delirium: A review

Grover

Kate²

2012

WJP

153

128

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Over the years many scales have been designed for screening, diagnosis and assessing the severity of delirium. In this paper we review the various instruments available to screen the patients for delirium, instruments available to diagnose delirium, assess the severity, cognitive functions, motoric subtypes, etiology and associated distress. Among the various screening instruments, NEECHAM confusion scale and delirium observation scale appear to be most suitable screening instrument for patients' in general medical and surgical wards, depending on the type of rater (physician or nurse). In general, the instruments which are used for diagnosis [i.e., confusion assessment method (CAM), CAM for intensive care unit (CAM-ICU), Delirium Rating Scale-revised version (DRS-R-98), memorial selirium assessment scale, etc. ] are based on various Diagnostic and Statistical Manual criteria and have good to excellent reliability and fair to good validity. Among the various diagnostic instruments, CAM is considered to be most useful instrument because of its accuracy, brevity, and ease of use by clinicians and lay interviewers. In contrast, DRS-R-98 appears to be a comprehensive instrument useful for diagnosis, severity rating and is sensitive to change and hence can be used for monitoring patients over a period. In the ICU setting, evidence suggests that CAM-ICU and Nursing Delirium Screening Scale had comparable sensitivities, but CAM-ICU has higher specificity. With regard to assessment of delirium in pediatric age group, certain instruments like Pediatric Anesthesia Emergence Delirium scale and pediatric CAM-ICU has been designed and have been found to be useful.

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Section: Instruments For Assessment Of Cognitive Symptoms Of Deliriummentioning

confidence: 99%

Assessment scales for delirium: A review

Grover

Kate²

2012

WJP

153

128

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“…Age, schooling and handedness were similar for groups of patients and controls, with no statistically significant difference. Despite the sample size, it is likely that this pairing helped minimize the effect that schooling might have had on some tests ("A" Random Letter Test 8 , visual perception of abstract forms 10 , auditory perception of phonemes 11 , constructional praxis). The size of the sample was an important limitation, though, for the inclusion of more patients might have confirmed the power of more tests with significant results for stroke localization.…”

Section: Discussionmentioning

confidence: 99%

A topographic study on the evaluation of speech and language in the acute phase of a first stroke

Oliveira

Damasceno

2011

Arq. Neuro-Psiquiatr.

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Evaluation of speech and language may help in localization of site and extension of brain lesions, particularly in the absence of other neurological signs or radiologically defined injuries. Objective: To verify what language tasks are best correlated to which brain regions, in order to develop a test for neurologists in emergency settings. Method: Thirty-seven adult first-stroke patients were submitted to cognitive and language tests, and then paired with thirty-seven healthy controls. Patients underwent CT and/or MRI for topographic correlation with test results (p<0.05). Results: All tests were able to distinguish patients from controls, but only word/sentence repetition, naming, ideomotor praxis and, non-significantly, comprehension and counting 1-20 predicted left hemisphere lesions. Repetition was related to perisylvian structures, comprehension to the posterior portion of the middle cerebral artery territory, and fluency to frontal lesions, while naming was accurate only for lesion side. Conclusion: Language and cognitive tasks can help in the localization of acute stroke lesions. Key words: linguistics, aphasia, apraxias, stroke, brain infarction, language, speech, disability evaluation.Um estudo topográfico da avaliação de fala e linguagem na fase aguda de um primeiro infarto cerebral RESUMO Avaliação de fala e linguagem pode ajudar na localização do sítio e da extensão de lesões cerebrais, especialmente quando ausentes outros sinais neurológicos ou radiológicos. Objetivo: Verificar quais tarefas linguísticas se correlacionam melhor com quais regiões cerebrais, a fim de desenvolver um teste para uso pelos neurologistas em emergências. Método: 37 pacientes e 37 controles pareados passaram por avaliação linguístico-cognitiva. Pacientes foram submetidos a TC e/ou RM para correlação topográfica com os resultados da avaliação (p<0,05). Resultados: Todos os testes diferenciaram pacientes de controles, mas apenas os de repetição de palavras/sentenças, nomeação, praxia ideomotora e, de forma não-significativa, compreensão e contagem 1-20 puderam predizer lesões no hemisfério esquerdo. Os testes de repetição estavam relacionados com estruturas perisylvianas, compreensão com a porção posterior do território da artéria cerebral média, e fluência com regiões frontais, enquanto os de nomeação localizavam apenas o lado das lesões. Conclusão: Testes linguístico-cognitivos podem ajudar a localizar infartos cerebrais agudos. Palavras-Chave: linguística, afasia, apraxias, acidente cerebral vascular, infarto encefálico, linguagem, fala, avaliação da deficiência.

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“…[1] A brief history of the acute symptoms had to be reported by the patient (whenever possible) or a relative, including data on cardiovascular risk factors and socialeducational information, along with a complete neurological exam and a succinct assessment for hearing impairment (listening to finger-scratching with closed eyes, in each ear at once) and visual acuity; [2] Patients were then tested for attentional deficits by means of the "A" Random Letter Test 7 , being required to tap the unimpaired hand on the desk immediately after hearing the letter "A" (75 letters were orally presented by the examiner, 20 of them were "A" letters); [3] Handedness was assessed according to a fivepoint scale of the Edinburgh Inventory 8 for performance in writing, tooth-brushing, catching food with a spoon, opening a box, drawing, using a knife without fork, sweeping the floor (upper hand on the broomstick), throwing a ball, holding scissors, and striking a match; [4] Visual perception was tested by showing the patients ten abstract figures in several levels of difficulty, each of them displayed for ten seconds, soon after which they would have to point to it among four other figures (scored as hit-or-miss) 9 ;…”

Section: Methodsmentioning

confidence: 99%

Global aphasia as a predictor of mortality in the acute phase of a first stroke

Oliveira

Damasceno

2011

Arq. Neuro-Psiquiatr.

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Objective: To establish whether vascular aphasic syndromes can predict stroke outcomes. Method: Thirty-seven adults were evaluated for speech and language within 72 hours after a single first-ever ischemic brain lesion, in blind association to CT and/or MR. Results: Speech or language disabilities were found in seven (87.5%) of the eight deceased patients and twenty-six (89.7%) of the twenty-nine survivors. Global aphasia was identified in eleven patients, all with left hemisphere lesions (nine mute; five deceased), consisting on a risk factor for death in the acute stroke phase (ρ=0.022). Age (z=1.65; ρ>0.09), thrombolysis (ρ=0.591), infarct size (ρ=0.076) and side (ρ=0.649) did not significantly influence survival. Absence of aphasia did not predict a better evolution, regardless of the affected hemisphere. Prevalence of cardiovascular risk factors was similar for all patient groups. Conclusion: Global aphasia in acute stroke can adversely affect prognosis, translated into impairment of dominant perisylvian vascular territories, with mutism as an important semiological element. Key words: linguistics, aphasia, stroke, brain infarction, language, speech, disability evaluation, prognosis.Afasia global prediz mortalidade na fase aguda de um primeiro acidente vascular cerebral isquêmico RESUMO Objetivo: Determinar se síndromes afásicas na fase aguda do infarto cerebral influenciam o prognóstico. Método: Avaliação para fala e linguagem de 37 adultos dentro de 72 horas após um primeiro infarto cerebral, em associação topográfica cega com TC e/ou RM. Resultados: Detectaram-se afasias ou disartria em 7 (87,5%) dos 8 pacientes falecidos, e em 26 (89,7%) dos 29 sobreviventes. Afasia global foi identificada em 11 pacientes, todos com lesões no hemisfério esquerdo (cinco óbitos; mutismo em nove), consistindo em fator de risco para mortalidade na fase aguda do acidente vascular cerebral isquêmico (ρ=0,022). Idade (z=1,65; ρ>0,09), trombólise (ρ=0,591), dimensões da lesão (ρ=0,076) e lado (ρ=0,649) não afetaram significativamente a sobrevivência. Ausência de afasia não prenunciou melhor evolução. Fatores de risco cardiovascular tiveram similar prevalência para todos os grupos de pacientes. Conclusão: Afasia global na fase aguda do infarto cerebral pode aumentar mortalidade, demonstrando envolvimento de território vascular perisylviano dominante, tomando-se mutismo como importante elemento semiológico. Palavras-chave: linguística, afasia, acidente cerebral vascular, infarto encefálico, linguagem, fala, avaliação da deficiência, prognóstico.

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The Mental Status Examination in Neurology

Cited by 138 publications

References 0 publications

Assessment scales for delirium: A review

Assessment scales for delirium: A review

A topographic study on the evaluation of speech and language in the acute phase of a first stroke

Global aphasia as a predictor of mortality in the acute phase of a first stroke

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