Mental status testing

Definition

Mental status testing is done to check a person's thinking ability, and to determine if any problems are getting better or worse. It is also called neurocognitive testing.

Alternative Names

Mental status exam; Neurocognitive testing; Dementia-mental status testing

How the Test is Performed

A health care provider will ask a number of questions. The test can be done in the home, in an office, nursing home, or hospital. Sometimes, a psychologist with special training will do more detailed tests.

Common tests used are the mini-mental state examination (MMSE), or Folstein test, and the Montréal cognitive assessment (MoCA).

The following may be tested:

APPEARANCE

The provider will check your physical appearance, including:

• Age
• Clothing
• General level of comfort
• Gender
• Grooming
• Height/weight
• Expression
• Posture
• Eye contact

ATTITUDE

• Friendly or hostile
• Cooperative or ambivalent (uncertain)

ORIENTATION

The provider will ask questions such as:

• What is your name?
• How old are you?
• Where do you work?
• Where do you live?
• What day and time is it?
• What season is it?

PSYCHOMOTOR ACTIVITY

• Are you calm or irritable and anxious
• Do you have a normal expression and body movement (affect) or display a flat and depressed affect

ATTENTION SPAN

Attention span may be tested earlier, because this basic skill can influence the rest of the tests.

The provider will check:

• Your ability to complete a thought
• Your ability to think and problem solve
• Whether you are easily distracted

You may be asked to do the following:

• Start at a certain number, and then begin to subtract backwards by 7s.
• Spell a word forward and then backward.
• Repeat up to 7 numbers forward, and up to 5 numbers in reverse order.

RECENT AND PAST MEMORY

The provider will ask questions related to recent people, places, and events in your life or in the world.

You may be shown three items and asked to say what they are, and then recall them after 5 minutes.

The provider will ask about your childhood, school, or events that occurred earlier in life.

LANGUAGE FUNCTION

The provider will determine if you can formulate your ideas clearly. You'll be observed for if you repeat yourself or repeat what the provider says. The provider will also determine if you have trouble expressing or understanding (aphasia).

The provider will point to everyday items in the room and ask you to name them, and possibly to name less common items.

You may be asked to say as many words as possible that start with a certain letter, or that are in a certain category, in 1 minute.

You may be asked to read or write a sentence.

JUDGMENT AND INTELLIGENCE

This part of the test looks at your ability to solve a problem or situation. You may be asked questions such as:

• "If you found a driver's license on the ground, what would you do?"
• "If a police car with lights flashing came up behind your car, what would you do?"

Some tests that screen for language problems using reading or writing do not account for people who do not read or write. If you know that the person being tested cannot read or write, tell the provider before the test.

If your child is having the test, it is important to help them understand the reason for the test.

Normal Results

Most tests are divided into sections, each with its own score. The results help show which part of someone's thinking and memory may be affected.

What Abnormal Results Mean

A number of health conditions can affect mental status. The provider will discuss these with you. An abnormal mental status test alone does not diagnose the cause. However, poor performance on such tests can be due to medical illness, brain disease such as dementia, Parkinson disease, or to mental illness.

References

Beresin EV, Gordon C. The psychiatric interview. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 2.

Gierus J, Mosiolek A, Koweszko T, Wnukiewicz P, Kozyra O, Szulc A. The Montreal Cognitive Assessment as a preliminary assessment tool in general psychiatry: validity of MoCA in psychiatric patients. Gen Hosp Psychiatry. 2015;37(5):476-480. PMID: 26054843 www.ncbi.nlm.nih.gov/pubmed/26054843.