Mental state examination - AMTS, MMSE, frontal lobe testing Flashcards

1
Q

What is the AMTS and its use?

A

Abbreviated mental test score (AMTS) is a 10-point assessment

Screens for both delirium and dementia, although further tests are necessary to confirm these diagnoses

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2
Q

What are the AMTS questions?

A
  1. Age
  2. Time to nearest hour
  3. Address to repeat - 42 West Street
  4. DOB
  5. Year
  6. Name of place
  7. Two people
  8. WW1 begin
  9. Monarch
  10. Count 20-1
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3
Q

What AMTS score indicates need for further assessment?

A

A score of 6 or less suggests delirium or dementia, although further tests are necessary to confirm the diagnosis.

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4
Q

What are 3 assessments of cognition?

A
  • Mini-mental state exam (MMSE)
  • Abbreviated mental test score (AMTS)
  • Addenbrooke’s cognitive examination III (ACE-III)
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5
Q

What is a common use of the MMSE?

A

assess the progression of Alzheimer’s disease

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6
Q

What scores on the MMSE suggest normal vs impaired cognition?

A

≥25 – Normal

21 – 24 – mild impairment

10 – 20 – moderate impairment

<10 – severe impairment

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7
Q

What do the questions assess in the MMSE?

A
  • Orientation to time
  • Orientation to Place
  • Registration
  • Attention and Calculation
  • Recall
  • Language
  • Repetition
  • Following complex commands

Out of 30 points

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8
Q
A
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9
Q

Give 3 advantages of the MMSE.

A
  • Relatively quick and easy to perform
  • Requires no additional equipment
  • Can provide a method of monitoring deterioration over time
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10
Q

Give 3 disadvantages of the MMSE.

A
  • Biased against people with poor education due to elements of language and mathematical testing
  • Bias against visually impaired
  • Limited examination of visuospatial cognitive ability
  • Poor sensitivity at detected mild/early dementia
  • Copyrighted and costs money
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11
Q

What are the signs of frontal lobe syndrome?

A

Executive dysfunction

  • Poor judgement
  • Poor reasoning and problem-solving
  • Poor planning and decision-making

Social behaviour and personality change

  • Loss of social awareness: irresponsible/ disinhibited/ inappropriate behaviour
  • Impulsivity
  • Euphoric or ‘fatuous’ mood; lability
  • Repetitive or compulsive behaviours

Apathy

  • Lack of motivation and initiative
  • Decline in self-care.

Depending on the part of the lobes most affected, people tend to be either apathetic or disinhibited, impulsive, aggressive, and socially inappropriate.

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12
Q

What are 3 causes of damage to the frontal lobe?

A
  • Dementia
  • Stroke
  • Head injury
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13
Q

Frontal lobe testing (1)

A

Frontal lobe testing (2)

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14
Q

Frontal lobe testing (3).

A
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15
Q

What is the Luria test?

A

Assesses ability to shift from one action to another

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16
Q

What does the no-go-tast involve and test?

A

Ability to inhibit an inappropriate response (i.e. here the patient has the urge to copy you, but has to inhibit this and do the opposite).

  1. When I touch my nose, you raise your finger, like this. - Show patient: point to the ceiling with your right index finger.
  2. And when I raise my finger, you touch your nose, like this - Show patient: touch your nose with your right index finger.
17
Q

Name two test for verbal fluency.

A

Tests for semantic memory (retrieval). Should score >15.

  1. FAS testing - e.g. words beginning with F for a minute, no names allowed
  2. Animals in a minute - alternative to FAS
18
Q

What tests are used for abstarct reasoning?

A

Proverbs e.g. people in glass houses shouldn’t throw stones. Ask about meaning of this. NB: don’t translate across cultures and different interpretation in ASD, ADHD, and schizophrenia.

Cognitive estimates e.g. how fast can a racehorse run? what is the best paid job in the country?

19
Q

What tests are used for primitive reflexes?

A

Frontal lobe should inhibit primitive reflexes but if damaged then they may reappear:

  • Grasp reflex - ask to stroke patient’s palm towards thumb
  • Suck/pout reflex - lightly tap patient’s lips or stroke down their philtrum
  • Rooting reflex - stroke the patient’s cheek with finger