Mental Status examination

Question 1

What is mental status testing?

Answer 1

A portion of the neuro exam that assesses mental function including consciousness

Question 2

Why is mental status testing important in PT?

Answer 2

To assess cognitive readiness and safety for therapy especially in patients with neurologic or cognitive concerns.

Question 3

What is arousal?

Answer 3

Physiologic readiness of the human system for activity.

Question 4

What is level of consciousness?

Answer 4

The state of arousal ranging from fully awake to comatose.

Question 5

What are the three major disorders of consciousness?

Answer 5

Coma vegetative state

Question 6

What defines a coma?

Answer 6

Complete loss of arousal no sleep-wake cycle

Question 7

What defines a vegetative state?

Answer 7

Has sleep-wake cycles but no awareness of self or environment

Question 8

What defines a minimally conscious state?

Answer 8

Partial conscious awareness inconsistent purposeful behaviors

Question 9

How is level of consciousness observed in awake patients?

Answer 9

By monitoring alertness and interaction during conversation or stimulation.

Question 10

How do you arouse an unresponsive patient?

Answer 10

Use progressive stimulation: verbal tactile

Question 11

What standardized tools assess arousal and consciousness?

Answer 11

Glasgow Coma Scale (GCS)
Rancho Los Amigos Cognitive Functioning Scale (RLOCF)

Question 12

What does the Glasgow Coma Scale (GCS) measure?

Answer 12

Level of consciousness in TBI patients; scores range from 3–15.

Question 13

What GCS score indicates severe TBI?

Answer 13

Score of 3–8.

Question 14

What is the Rancho Los Amigos Scale used for?

Answer 14

Describing cognitive/emotional behaviors during recovery from coma or minimally conscious state.

Question 15

What is Level I of RLOCF?

Answer 15

no response, total assistance needed.

Question 16

What is Level IV of RLOCF?

Answer 16

Confused and agitated needs maximal assistance.

Question 17

What is Level VIII of RLOCF?

Answer 17

Purposeful and appropriate stand-by assistance required.

Question 18

What is orientation?

Answer 18

The ability to understand and adjust to person place

Question 19

What does “A&O x3” mean?

Answer 19

Alert and oriented to person, time and place

Question 20

What does “A&O x4” mean?

Answer 20

Alert and oriented to person, time, place and situation

Question 21

What is attention?

Answer 21

attention is the ability to focus one’s consciousness on specific information

Question 22

Why is attention important in rehab?

Answer 22

important component of learning and first step in forming memories

Question 23

Which brain hemisphere typically controls attention?

Answer 23

Non-dominant hemisphere, usually the right.

Question 24

What is Selective attention?

Answer 24

The ability to select important/relevant information while ignoring other sources of information

Question 25

What is divided attention?

Answer 25

The ability to process more than one source of information or to perform more than one task at a time

Question 26

Alternating/ switching attention

Answer 26

The ability to switch attention between two tasks or sources of information as needed for the task and environment

Question 27

How is sustained attention tested?

Answer 27

Repeating progressively longer number strings or tapping to a specific letter.

Question 28

What is divided attention testing?

Answer 28

Asking a patient to perform two tasks at once (e.g.Walking While Talking Test).

Question 29

What does the WWTT assess?

Answer 29

Divided attention and fall risk in older adults.

Question 30

What are cutoff times for WWTT?

Answer 30

>20 sec for simple task >33 sec for complex task = higher fall risk.

Question 31

What are standardized tests for cognition?

Answer 31

MMSE and MoCA.

Question 32

What is the MoCA cutoff score for possible cognitive impairment?

Answer 32

<26

Question 33

How can therapists manage attention deficits in PT?

Answer 33

Reduce distractions use direct cues

Question 34

What is memory?

Answer 34

The ability to acquire store, and recall (remember) information from the past 

Question 35

What are the two main types of memory?

Answer 35

Explicit (declarative) and implicit (procedural).

Question 36

What is explicit memory?

Answer 36

Conscious memory for facts and events (e.g.steps to complete a task).

Question 37

What is implicit memory?

Answer 37

Unconscious memory for skills and procedures (e.g.tying shoes).

Question 38

What brain areas affect explicit memory?

Answer 38

Temporal lobe and hippocampus.

Question 39

What is immediate memory?

Answer 39

Recalling information seconds after hearing it.

Question 40

What is short-term memory?

Answer 40

Recall of recent events (minutes to hours).

Question 41

What is long-term memory?

Answer 41

Recall of distant past events and learned knowledge.

Question 42

What is a good short-term memory test example?

Answer 42

Ask patient to recall 3 items immediately then again after 5 minutes.

Question 43

What are red flags during cognitive screening?

Answer 43

Inconsistent answers, avoidance trouble filling things out or describing the problem

Question 44

What medications can affect cognition in older adults?

Answer 44

Benzodiazepines, anticholinergics or dopaminergic medications

Question 45

What is bradyphrenia?

Answer 45

Slowness of thought, common in Parkinson’s disease.

Question 46

Why screen cognition in inpatient settings?

Answer 46

Patients may have fluctuating arousal or attention due to illness or medications.

Question 47

What is the recommended test sequence for mental status?

Answer 47

Arousal orientation attention and memory other cognitive tests

Question 48

What is a therapist-friendly intro to cognitive testing?

Answer 48

"These questions check your thinking and memory to help guide your therapy."

Question 49

What tools screen for depression in older adults?

Answer 49

Geriatric Depression Scale (GDS) Beck Depression Inventory.

Question 50

What are the GDS scores?

Answer 50

0 to 4 are considered normal 5 to 8 indicate mild depressive symptoms 8 to 11 indicate moderate depressive symptoms 12 to 15 indicate severe depressive symptoms

Question 51

What is communication in a clinical setting?

Answer 51

the ability to convey and receive information through: auditory (talking) nonverbal ( gestures, eye contact, sign language) writing (words, pictures, symbols)

Question 52

What is aphasia?

Answer 52

Impairment in speech comprehension or production due to left hemisphere lesion.

Question 53

What is alexia?

Answer 53

Difficulty understanding written language.

Question 54

What is agraphia?

Answer 54

Inability to write.

Question 55

What is dysarthria?

Answer 55

Motor speech difficulty due to CNS or PNS damage.

Question 56

Why is communication screening important in PT?

Answer 56

It affects instruction and participation

Question 57

What can improve communication with language-impaired patients?

Answer 57

slow rate speech Use short phrases avoid dual tasks narrow down context direct wording

Question 58

How to increase message saliency?

Answer 58

Emphasize key words

Question 59

What does "increase redundancy" mean in PT instructions?

Answer 59

Use multiple formats—verbal visual

Question 60

Why assess cognition from the start of an encounter?

Answer 60

Behavioral cues may reveal issues before formal screening.

Question 61

What is anosognosia?

Answer 61

Unawareness of one's own deficits.

Question 62

How can therapists respond to anosognosia safely?

Answer 62

Let patients make controlled mistakes in a safe environment.