heMentalStatusExamination(MSE)-PalmerCollegeof精神状态检查(MSE)-帕大学

1、The Mental Status Examination (MSE)第一页，共三十七页。Mental StatusMental status is the total expression of a persons emotional responses, mood, cognitive function, and personalityIt is closely linked to the individuals executive functioning, i.e. motivation, initiative, goal formation, planning and performi

2、ng, self-monitoring, and integration of feedback第二页，共三十七页。Quick Neurology ReviewFrontal lobe Speech formation (Broca area)Emotions/affectDrive Awareness of selfShort-term memory Goal-oriented behavior第三页，共三十七页。Quick Neurology ReviewParietal lobe Sensory perceptionSpatial sense and navigation第四页，共三十七

3、页。Quick Neurology ReviewTemporal lobe Perception and interpretation of sounds Wernickes area Integration of behavior, emotion, and personalityLong-term memory第五页，共三十七页。Quick Neurology ReviewLimbic system Survival behaviors (mating, aggression, fear, affection)Reactions to emotions, and expression of

4、 affect is mediated by connections of the limbic system and the frontal lobe第六页，共三十七页。DementiaDementia is a clinical syndrome, characterized by deteriorating cognition, behavior, and functional independenceIt is usually related to obvious structural disease of the brain (most commonly atrophy)Dement

5、ia affects 3-11% of adults older than 65第七页，共三十七页。Mnemonic for causes of dementiaD: drugs and toxinsE: endocrineM: metabolic and mechanicalE: epilepsy N: nutritional and nervous systemT: tumor and trauma I: infectionA: arterial 第八页，共三十七页。DeliriumDelirium is different than dementia It is an acute con

6、fusional state accompanied by a disorder of perceptionSymptoms include alterations in mental status (disorientation), attention span, sleep patterns, and affectSudden and fluctuatingUsually reversible第九页，共三十七页。Mental Status Examination The MSE is one component of an exam and may be viewed as the psy

7、chological equivalent of the physical examIt is an important component to a neurological evaluation第十页，共三十七页。Factors affecting the MSECulture and educational background of the patient What is abnormal for a person with high intellectual ability may be normal for a person of less educationPatients wi

8、th ESL may have difficulty with some components of the exam第十一页，共三十七页。Major Components of the MSEAppearance MotorSpeechAffect & moodThought ContentThought ProcessPerceptionIntellectInsight第十二页，共三十七页。AppearanceAgeGenderRaceBody buildPostureEye contact DressGroomingMannerAttentiveness to examinerEmoti

9、onal facial expressionAlertness第十三页，共三十七页。MotorBehavior: Pleasant? Cooperative? Appropriate for the particular situation? HesitancyAgitationAbnormal movementsGaitCatatonia第十四页，共三十七页。SpeechRate Rhythm VolumeAmount Articulation Spontaneity第十五页，共三十七页。Affect and MoodAffect: How do they appear to you?Sta

10、bilityRangeAppropriatenessIntensityMood: Dr. asks the patient directly how he/she feels第十六页，共三十七页。Thought ContentSuicidal ideationDeath wishesHomicidal ideationDepressive cognitionObsessionsRuminationsPhobiasParanoid ideationMagical ideationDelusionsOvervalued ideasDescription of what the patient is

11、 thinking about第十七页，共三十七页。Thought ProcessAssociationsCoherenceLogicStreamClang associations PerseverationNeologism Thought blockingAttentionDescription of the way in which the patient thinks第十八页，共三十七页。PerceptionHallucinationsIllusionsDepersonalizationDerealizationdj vujamais vu第十九页，共三十七页。IntellectGl

12、obal impression: average, above average, below average第二十页，共三十七页。InsightAwareness of illness第二十一页，共三十七页。MSEThe full MSE is a lengthy examYou assess many components of the MSE in your normal work up of a patientWhen you need to do a shorter neurological screening exam, you may shorten the MSE to the

13、Mini Mental Status Exam (MMSE)第二十二页，共三十七页。MMSETakes approximately 10 minutesThe MMSE tests:OrientationImmediate and short-term memoryConcentration Arithmetic ability LanguagePraxis (learning)第二十三页，共三十七页。MMSEOrientation:What is the (year) (season) (date) (day) (month)? Where are we?(state) (country)

14、(town) (office) (floor) 5 pointsRegistration:Name 3 objects, taking 1 second to name each. Then ask the patient to repeat them. 1 point for each correct.Attention and Calculation:Ask the patient to count backwards from 100 in 7s. Stop after 5 answers. Alternatively, ask the patient to spell “world b

15、ackwards. 1 point for each correct answer (5)1 point for each correct answer (5)1 point for each correct answer (3)1 point for each correct answer (5)第二十四页，共三十七页。MMSERecall:Ask the patient for the 3 objects named under “Registration.Language:Point to two objects and ask the patient to name them (pen

16、 and watch).Ask the patient to repeat “No ifs, ands, or buts.Ask the pt. to follow a 3-step command: “Take this paper in your right hand, fold it in half, and put it on the table.Ask the pt. to read and obey the following: “Close your eyes. Write a sentence. Copy a drawing of intersecting pentagons.

17、 1 point for each correct answer (3) 1 point for each correct answer (2)1 point for correct answer (1) 1 point for each correct task (3)1 point for correct task (1)1 point for correct task (1)1 point for correct task (1)Total (30) 第二十五页，共三十七页。Interpretation of the MMSEThe traditional threshold for t

18、he MMSE is a score of 23 or greaterScores of 0-23 argue strongly for the diagnosis of dementiaBut, false-positive results are a concern when applied to large populations with low incidence of dementia, so some experts prefer the following scoring system:0-20: dementia highly probable26-30: dementia

19、highly unlikely21-25: results not conclusive第二十六页，共三十七页。The MMSE is a copyrighted psychological test published by Psychological Assessment Resources (PAR), Inc. 第二十七页，共三十七页。So, why do DCs need to do MSEs?Emotional and behavioral changes are often the first signs of organic brain diseaseDoes the pati

20、ent see his or her M.D. as frequently as he or she sees you, the chiropractor? Brain tumors, subdural hematomas, small infarcts, and cerebral atrophy may be undetected on routine neurological examination, whereas the cognitive effects of these lesions may be apparent on an MSE第二十八页，共三十七页。DrawbacksDo

21、es a normal MSE or MMSE indicate competence? NoCompetence relates to a pt.s ability to provide food & shelter, to manage $, and to participate in activities and decisionsPts. who score well may have difficulty with basic activities of daily living 第二十九页，共三十七页。DrawbacksDoes an abnormal MSE or MMSE in

22、dicate incompetence?Not necessarilyMany pts. with cognitive limitations develop alternative means of coping with deficits, allowing them to live fairly independent lives第三十页，共三十七页。DrawbacksThe MSE and MMSE screenings have limitations They are subject to interpretive bias and experience of the interv

23、iewer They have a fairly significant false-negative rate, esp. in pts. with right hemisphere lesionsDemographics and culture: Age (60), education (9th grade), limited cultural experiences, and low socioeconomic status limit usefulness Screening questionnaires are less sensitive to cognitive impairme

24、nts第三十一页，共三十七页。Do you have to be a DC & a Psychiatrist/Psychologist? No. It is not realistic to expect that you evaluate a patient to the same level of a psychiatrist or a psychologist But, a large part of a persons overall health is his or her mental health As subluxations may be caused by “thought

25、s, a persons mental status should be important to you第三十二页，共三十七页。Documentation of Mental StatusDocumentation of the patients mental status is not remarkably different than the documentation for the history exam or physical examInclude it in the Neurology section of your narrative history第三十三页，共三十七页。

26、Example of normal: “The patient is alert and oriented x 3. Correct registration of 3 objects was noted. Attention and calculation are appropriate with serial 7 counting. Short term memory is intact. Language skills are demonstrated without evidence of agnosia, aphasia or apraxia. 第三十四页，共三十七页。Example of abnormal