Chapter 42 Neurology
Neurologic Examination
Mental Status Examination
The mental status examination assesses appearance and behavior (including level of consciousness), speech and language, mood, thoughts and perceptions, and cognition. Speech abnormalities can interfere with the initial history. Abnormalities of speech include hearing deficits, aphasia (problems with understanding, thought, and word finding), and dysarthria (problems with articulation). Aphasia results from damage to the dominant hemisphere. Wernicke’s aphasia refers to poor comprehension, with fluent but often meaningless speech. In Broca’s aphasia, comprehension is preserved, but speech is nonfluent. Repetition, naming, reading, and writing are impaired in Wernicke’s and Broca’s aphasia. With conductive aphasia, there is a loss of repetition but preserved comprehension. Reading comprehension is thus relatively preserved, but reading aloud and writing are impaired. Dysarthria refers to difficulties with the production of speech caused by injury to the vocal cords, larynx, palate, tongue, or facial muscles. It is also seen with extrapyramidal or cerebellar lesions. Cognitive function is often assessed by tools such as the Mini–Mental State Examination, a simple, quick screening test for cognitive function. Errors in copying several simple drawings can be indicative of organic brain damage, particularly in those with dementia or parietal lobe damage.
