One of the challenges facing behaviorally oriented neurologists is that many patients' symptoms fall beyond the scope of a physical neurological evaluation. Frequently, patients with neurodegenerative disease, particularly in the early stages, present with intact cranial nerves, reflexes, eye movements, and sensory-motor function. Accordingly, clinicians need tools to formally assess the cognitive, psychiatric and behavioral abnormalities that define many dementing disorders. The mental status examination is the part of the neurological examination that assesses current mental capacity through evaluation of appearance, mood, perceptions (e.g. delusions, hallucinations) and all aspects of cognition (e.g. attention, orientation, memory).
According to Frey (2002), a comprehensive mental status examination evaluates 10 areas of functioning: (1) overall appearance, (2) movement and behavior (gait, coordination, eye contact and facial expressions), (3) mood (underlying emotional tone of person's answers), (4) affect (outwardly observable emotional reactions), (5) speech (volume, rate, tone, appropriateness and clarity), (6) thought content (hallucinations, delusions, obsessions, dissociative symptoms and thoughts of suicide), (7) thought process (repeated words or phrases, thought blocking, illogical connections), (8) cognition, (9) judgement (what to do about a common sense problem) and (10) insight (ability to recognize a problem and understand its nature and severity). This chapter will describe some widely used approaches for assessing mental status, with a particular emphasis on the cognitive changes typically seen in neurodegenerative disease.
Several standardized mental status examinations exist that enable quantification of cognitive impairment, typically yielding a single composite score that reflects disease severity.