Mental status - will use the ACE-R approach
The the Folstein Mini Mental Status Examination is widely used as a structured, quantittive screen of mental status. It is sensitive to metabolic encephalopathy/delirium but not sensitive to dementia, and is particularly insensitive to frontal lobe dysfunction.
Impairment of mental status is usually first suspected from the referral, behaviour of the patient when arranging the appointment, comments and concerns of relatives or caregivers, or the person's responses and actions during introductions and the interview.
Low intellect, poor education and cultural difference or deprivation may disguise or incorrectly suggest cognitive impairment.
Special caution with interpretation is needed in the presence of dysphasia, since examination depends on communication. Impaired memory or frontal lobe function may be disguised by retained social graces which is a feature of Alzheimer's disease.
Areas to test
Registration - the ability to retain and recall a small amount of information briefly
Anterograde memory - recall of events since the illness began, and to make new memories.
Retrograde memory - recall of significant events that occurred pre-illness
Language, including reading and writing
The Addenbrooke's Cognitive Examination - revised extends the Folstein and allows a MMSE score to be derived. It has normative values for the score allowing a reasonably definitive decision on the presence or absence of dementia.