Bedside Approach to the Mental Status Assessment

David F. Tang-Wai, MDCM, FRCPC; ; Morris Freedman, MD, FRCPC, FAAN; Behavioral Neurology and Psychiatry p. 672-703 June 2018, Vol.24, No.3 doi: 10.1212/CON.0000000000000617
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PURPOSE OF REVIEW: This article presents a clinically useful approach to obtaining the history and performing the mental status examination of patients with cognitive, language, or behavioral problems.

RECENT FINDINGS: Laboratory and imaging biomarkers are being developed for accurate diagnosis of neurobehavioral disorders, yet few are currently available for clinical use. Moreover, not all centers have access to these potential tools. Practicing clinicians are therefore left primarily with their skills of history taking and examination. Although geared for research, diagnostic criteria have been refined over the past several years and can nevertheless aid the clinician with the diagnosis of disorders such as mild cognitive impairment, Alzheimer disease, frontotemporal dementia, dementia with Lewy bodies, the primary progressive aphasias, corticobasal syndrome, vascular cognitive impairment, and posterior cortical atrophy. Regularly revised criteria reflect ongoing knowledge gained from in-depth studies of these disorders.

SUMMARY: The focused history and mental status examination remain essential tools for the evaluation and diagnosis of neurologic disorders affecting cognition, language, and behavior.

Address correspondence to Dr David F. Tang-Wai, University Health Network Memory Clinic, Toronto Western Hospital, 399 Bathurst St WW5-441, Toronto, ON M5T 2S8, Canada, David.Tang-Wai@uhn.ca.

RELATIONSHIP DISCLOSURE: Dr Tang-Wai has provided expert legal testimony for the Canadian Medical Protection Association on a case determining if a patient had cognitive impairment. Dr Freedman serves as a trustee for the World Federation of Neurology and on the editorial boards of Brain and Cognition and Journal of Parapsychology; has received support from and served on an advisory board for Eli Lilly and Company Canada and receives publishing royalties from Oxford University Press; receives research/grant support from the Alzheimer Society of Canada, Brain Canada Foundation, Centre for Aging and Brain Health Innovation, Canadian Institutes of Health Research, and Westin Brain Institute; receives support from the Behavioural Neurology Physician Recognition Covenant Fund at Baycrest, the Morris Kerzner Memorial Fund, and the Saul A. Silverman Foundation as part of the Canada International Scientific Exchange Program project; and holds stock in companies producing or planning to produce medical marijuana and is listed on a provisional patent related to methods and kits for differential diagnosis of Alzheimer disease.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Tang-Wai and Freedman report no disclosures.

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© 2018 American Academy of Neurology