FLORIDA MENTAL STATUS EXAM (FMSE) (Doty, Bowers,.doc

FLORIDA MENTAL STATUS EXAM (FMSE) (Doty, Bowers, & Heilman, 1990)DATENAMEADDRESS PHONE MEDICAL RECORD # (MR #) HANDEDNESS SEX AGE DATE OF BIRTH MARITAL STATUS RACE EDUCATION COMPLETEDGRADES REPEATED PAST/PRESENT OCCUPATION Has family or patient noticed change in memory, thinking or drive? YES NO DIAGNOSISNAME OF EXAMINER DIRECTIONS TO EXAMINER: Please complete each test item, and score as you test. Note your observations and extra comments on the test pages. You need the following object: pencil with eraser, pen with clip, watch with watchband, and blank sheet of paper. Be sensitive to vision and hearing needs of patients. Report performance on each section, ie attention, intention, etc.:Mark (X) to show level of consciousness: Alert Drowsy StuporComa * * * * * * * * * * * * * * * * * * * * * * *MINI MENTAL STATUS (Folstein, Folstein & McHugh, 1975)(Score marked F = identify item on Folstein Mini-Mental Status Exam). Maximum Score Actual Score1. Orientation III.C (1-10) (10 points) 2. Registration III.D (3 points) 3. Attention (world *) / Calculation III. J (5 points) _ * Score for “world backwards (1 point a letter) 4. Recall III.F (3 points) _5. Language: IV.B. Naming (2 points); IV.C.3 Repeating (9 points) _ (1 point); IV.D.2 Action (3 points); IV.E.1 Reading (1 point); IV.F. Sentence (1 point); VI.A. Copying (1 point)TOTAL SCORE (30) _FSME Page 2Name _ MR# _I.ATTENTIONA. DISTRACTIBILITY: (TEST VISUAL FIELDS): Ask patient to fixate on your nose. Hold right (R) and left (L) index finger about 15 inches on each side of and toward front of patients face. First check to see if patient can point to or tell when right or left fingers move. Then ask patient, “Keep looking at my nose and point to or tell me when right or left finger moves.” Give these 6 trials: R,L,L,R,R,L. Score number of times the patients eyes do not deviate toward the moving finger. SCORE _B.DIGIT SPAN (FORWARD): Ask patient, “Repeat each group of numbers in the same order that I say them.” Read numbers at rate of one each second. Score is groups of numbers correct.NUMBER GROUPWRITE RESPONSECORRECTINCORRECT1. 8-4-72. 9-3-4-13. 5-1-6-2-94. 6-4-3-5-2-75. 3-9-2-6-4-8-5 SCORE _C. CANCELLATION: Ask patent, “Mark through all the As” (following page).Place paper at midline in front of patient. Score 1 for each A canceled. SCORE _II. INTENTIONA. IMPERSISTENCE: Ask patient, “Close your eyes until I say open them.” Time patient for 15 seconds. Score is number of seconds eyes stay closed.SCORE _ B.GENERAL ACTIVITY (MOVEMENT): Observe patient during exam. Rank the general amount of movement on the line below. -5 -3 0 +3 +5 Very Slow (Akinetic) Mildly Slow Normal Mildly fast Very Fast (Manic) SCORE _FSME Page 4 Name_ MR#_ C. CONTRASTING PROGRAMS (1-2, 2-1): Instruct the patient, “Make a fist. When I raise one finger, you raise two fingers. When I raise two fingers, you raise one finger.” Fingers are lowered completely between trials. Give 10 trials. Raise fingers in this order: 1112122221. Score 1 for each correct response. SCORE_ D. WORD FLUENCY: Ask, “Within one minute, give as many words as possible that begin with a letter that I will tell you. Do not give proper names or derivatives (i.e., go, goes, gone). Start now and use the letter F.” Write patients responses verbatim here. Score is number of correct words in 60 seconds. Repeat using letter “A”. Repeat with “S”. SCORE_ F/ A/ SIII. VERBAL MEMORYA. HOPKINS VERBAL LEARNING TEST (*Brandt, 1991). Directions: Say, “Listen carefully as I read the word list and try to memorize the words.” Then read the word list aloud (one word every 2 seconds). Record words the patients freely recalls. Score is the number of correct words. Repeat trial twice. (Second part of this test at end of FMSE.)Part 1: Free Recall (Form 1: four-legged animals, precious stones, human dwellings) Trial 1Trial 2Trial 3LIONEMERALDHORSETENTSAPPHIREHOTELCAVEOPALTIGERPEARLCOWHUT#CORRECT _ _(Total Score Part 1 is sum of # correct for trials 1, 2, and 3). SCORE 1 _Remember the rest of this test (Parts 2 & 3) at end of FMSE (after a delay of 20 minutes). FSME Page 5 Name_ MR_B. BOSTON NAMING TEST (BNT) (Kaplan, Goodglass & Weintraub, 1983) (Copy of BNT in Neurology Clinic or Department of Neurology)Starting Point (# of picture) _ End Point (# of picture) _Words Correct _ + Words Incorrect _ = Total words tried _ SCORE _C. ORIENTATIONF: Score 1 for each correct answer:QUESTIONCORRECTINCORRECT1. What is the date today?2. What is the day of the week?3. What is the month?4. What is the year?5. What is the season of the year?6. What is the name of this place?7. What state is this place in?8. What city is this place in?9. What is your home address?10. What floor of the building are we on?SCORE_D. REGISTRATIONF: Instruct patient, “I will give you three words to remember, first repeat them immediately, and again later when I ask you.” Next say, “rose, umbrella, fear” (place words one second apart). Then ask patient to repeat the 3 words. Score number of words repeated. NOTE: If patient fails to repeat all 3 words immediately, try again (up to 6 trials) until patient repeats all 3 words. Extra trials are not scored. If patient cannot learn to repeat three words, recall cannot be assessed here. SCORE_E. DISTRACTORF: (Calculation) Ask patient, “Start with 100 and repeatedly subtract by 7.” Stop after 5 subtractions (93, 86, 79, 72, 65). Score number of correct responses. SCORE_F. SHORT TERM RECALLF: Ask patient, “What are the three words I asked you to remember?” (rose, umbrella, fear) Score number of correct words. SCORE_G. LONG TERM RECALL: (Ask at end of test.) SCORE A_ SCORE B _H. REMOTE MEMORY: Ask patient to name the current and past four Presidents.Score number correct. SCORE_ I. CALCULATION: See Distractor (E above). If patients scored less than 5 correct, redo calculation, one step at a time. Ask “Start with 100; repeatedly subtract by 7. 100 take away 7 equals.” etc. Score number of correct responses. SCORE_J. F Ask patient, “Spell World backwards”. Score is number of letters in correct order. SCORE_FSME Page 6 Name_ MR_IV. LANGUAGE AND RELATED FUNCTIONSA. SPONTANEOUS SPEECH: Listen to patients spontaneous speech during exam and score as on chart. Ask about education, early jobs, family, etc. to encourage sample of speech. Score by describing: Fluency, Paraphasia, and Circumlocution.SPEECH FACTORSCORE 2SCORE 1SCORE 0SUBTOTAL1. Fluencya. PaceAverageAbnormal (slower or faster than average). Check one:a. Slower _b. Faster _Very abnormal Check one:a. Too slow _b. Too fast _b. Quantity of WordsAverageCheck if present:a. Too few words _b. Too many words _Check if present:a. Mute _b. Nonstop talking _c. GrammarComplexShort, simple sentences.One word answers or frequent incorrect grammar.d. ArticulationNormalMildly impairedSeverely impaired (most words very hard to understand).2. Paraphasic ErrorsNoneOccasional.Check type:a. Semantic _(wrong word)b. Phonemic _ (wrong sound in word)c. Both_Common (occurs in most expressions or sentences). Check type:a. Semantic_b. Phonemic _c. Both _3. Circumlocution Errors (talks in Round about way Rather than uses Right word). NoneOccasionalCommon (occurs in most expressions or sentences).SCORE (Fluency, Paraphasia, & Circumlocution) _ FSME Page 7 Name_ MR_B. NAMINGF: Place at random a watch and a pencil on a table. Point to each object; ask: “What is this?” or “What is this called?” Score is number correct. OBJECTCORRECTINCORRECT1. Pencil2. WatchSCORE _C. REPETITION: Ask patient, “Repeat each sentence I say.” Score is # of sentences correct. SENTENCECORRECTINCORRECT1. I am here.2. The President lives in Washington3. F No ifs, ands, or buts. SCORE_D. COMPREHENSION: Ask patient, “Please do what I say.” Score is number correct.TASKCORRECTINCORRECT1. Point to the ceiling2. Take a piece of paper in your hand, fold it in half and put it on the floor.3. Before pointing to the door, point to the light.SCORE_ E. READING: Instruct patient, “Read and do what each sentence below says.” Cover the rest of the page so patient sees only the following sentences. Score is number correct.SENTENCECORRECTINCORRECT1.F Close your eyes2. Point to the floor.3. Do not point to the chair, but do point to the table.SCORE_FSME Page 8 Name_ MR_F. WRITINGF: Ask patient to write a complete sentence about the weather. Do not dictate a sentence; it is to be written spontaneously. It must contain a subject and verb and be sensible. Score is correctness of grammar, spelling; describe penmanship. SCORE_G. PRAXIS: Instruct patient to show (pantomime) use of tools after you give an example, using a key. Do not use finger as key; body part as tool is wrong. Ask, “Pretend to hold and use the following tools.” Score is number correct.TOOLCORRECTINCORRECT1. Hammer2. Screwdriver3. Scissors SCORE_H. FINGER NAMING: Ask for name of fingers. Score is number correct. FINGERCORRECTINCORRECT1. Thumb2. Forefinger (index, dog, pointer)3. Little finger (pinkie) SCORE_I. RIGHT-LEFT CONFUSION: Score is number correct.TASKCORRECTINCORRECT1. Ask patient, “Show me your left hand.”2. Ask patient, “Point to my right hand”3. Ask patient, “Point to your right hand”4. Ask patient, “Point to my left hand”5. Ask patient, “Put your left hand on my right hand” SCORE_J. CALCULATIONS: Record here score from Distractor or Calculation tasks (page 5.) SCORE_FSME Page 9 Name_ MR_V. VISUAL SPATIALA. COPYINGF: Ask patient to copy the figure exactly. All angles must be present and 2 must intersect to score 1 point. Ignore tremor and rotation. SCORE 1 OR 0_B. MAPPING: (See map of USA on next page.) Have patient locate the following places. Mark (X) on each place on map. Score is number correct.PLACECORRECTINCORRECT1. Florida2. California3. Texas4. Oregon5. MaineSCORE_FSME Page 10 Name_ MR_FSME Page 11 Name_ MR_III. (Contd) MEMORY (Continued from Section III, Page 5, G. LONG TERM RECALLA. Long Term Recall: Ask patient to recall the three words give earlier (rose, umbrella fear). Score is number of correct words. (Add score to Verbal Memory Section G, middle of page 5). III. (Contd) MEMORY (Continued from Section III, Page 4.A. HOPKINS VERBAL LEARNING TEST (Part 2).Part 2: Long Term Recall from Hopkins Verbal Learning Test. For patients who score 20 or above on the Hopkins test, Section A, ask, “Earlier I read you a long list of words three times. Tell me all of those words that you can remember.”WORDS LISTEDCORRECTLIONEMERALDHORSETENTSAPPHIREHOTELCAVEOPALTIGERPEARLCOWHUTSCORE 2 _ Part 3: HOPKINS VERBAL LEARNING TEST (Brandt, 1991). RECOGNITION Read 24 words listed below and ask patient, “Say YES after each word that was on the first list and NO after each word that is new.” Score as directed. SCORE 3_ Part B: RecognitionHORSEruby*CAVEballooncoffeeLIONHouse*OPALTIGERboatscarfPEARLHUTEMERALDSAPPHIREdog*apartment*pennyTENTmountaincat*HOTELCOWdiamond*# True Positives _/12# False Positives Errors Related_/6Unrelated _/6Discrimination Index (# True Positives) (# False Positives) = _FSME Page 12 Name_ MR_V. Visual Spatial (Continued from page 9, Copying)C. VISUAL MEMORY: Ask patient “In the space below, draw from your memory the figure you copied a moment ago.” As before, all angles must be present and 2 must intersect to score 1 point. Score 1 or 0 SCORE_VI. METAMEMORY: Ask, “Mark an X to show how well you think you did on the last list of words. 035710Few CorrectAverageMany correct Ischemia Score (Hachinski et al., 1975)Abrupt