How the Test is Performed

A nurse, physician, physician assistant, or mental health worker will ask a number of questions. The test can be performed in the home, in an office, nursing home, or hospital. Occasionally, a psychologist with special training will do more extensive tests.

Most of the time, the provider will use neurocognitive tests that are also used by many other providers, which gives a score at the end. The most common test used is called the mini-mental state examination (MMSE) or Folstein test.

The following areas may be tested:

APPEARANCE

The health care provider will check the person's physical appearance, including:

• Age
• Dress
• General level of comfort
• Gender
• Grooming
• Height/weight

ORIENTATION

The health care provider will ask questions that may include:

• The person's name, age, and job
• The place where the person lives, type of building, city, and state, or the hospital or facility they are currently in
• The time, date, and season

ATTENTION SPAN

Attention span may be tested earlier, because this fundamental skill can influence the rest of the tests.

The provider will want to test:

• The person's ability to complete a thought
• The person's ability to think and problem solve
• Whether the person is easily distracted

A person may be asked to do the following:

• Start at a certain number, and then begin to subtract backwards by 7s.
• Spell a word such as "WORLD" forward, and then backward.
• Repeat up to 7 numbers forward, and up to 5 numbers in reverse order.

RECENT AND PAST MEMORY

The provider will ask questions related to recent people, places, and events in the person's life or in the world.

Three items may be presented, and the person may then be asked to repeat them, and then recall them after 5 minutes.

The provider will ask about the person's childhood, school, or events that occurred earlier in life.

LANGUAGE FUNCTION

The provider will point to everyday items in the room and ask the person to name them, and possibly to name less common items.

The person may be asked to follow a 1-step, 2-step, and 3-step instruction.

The provider may ask the person to say as many words as possible that start with a certain letter, or that are part of a certain category, in 1 minute.

The person may be asked to read or write a sentence.

JUDGMENT

To test the person's judgment and ability to solve a problem or situation, the provider might ask questions such as:

• "If you found a driver's license on the ground, what would you do?"
• "If a police officer approached you from behind in a car with lights flashing, what would you do?"

How to Prepare for the Test

No preparation is necessary for these tests.

How the Test Will Feel

There is no physical discomfort. Some people might find it stressful to answer all of the questions. Difficulties answering could lead to frustration.

Normal Results

The most commonly used test, the mini-mental state examination (MMSE) or Folstein test, is scored from 0 to 30. The test is also divided up into sections, each one with its own smaller score. These results may help show which part of someone's thinking and memory may be affected.

What Abnormal Results Mean

A number of conditions or problems can affect mental status:

• Alcohol intoxication
• Certain drugs and medications
• Encephalopathy, either chronic or acute
• Head trauma or concussion
• Many psychiatric conditions
• Many neurologic conditions
• Withdrawal from narcotics and barbiturates

See the following for a complete list of causes and treatments:

• Dementia
• Dementia due to metabolic causes
• Memory loss

Risks

There are no risks with these tests.

Considerations

Some tests that screen for language problems using reading or writing do not account for people who may never have been able to read or write. If you know that the person being tested has never been able to read or write, tell the health care provider in advance.

If your child is having any of these tests performed, it is important to help him or her understand the reasons for the tests.

Alternative Names

Mental status exam; Mental status tests

References

Snyderman D, Rovner B. Mental status exam in primary care: a review. Am Fam Physician. 2009;80:809-814.

Update Date: 3/9/2012

Reviewed by: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.