The Mental Status Examination in Neurology, 3d ed.

Strub RL, Black FW. Philadelphia, PA 19103-1493, FA Davis Co, 1993, paperback, 244 pp, illus, $24.95.

The first edition of this book provided guidelines for performing a mental status screening evaluation. The authors expand the test in this volume to present a standard mental status examination, with adult age-related norms for some of the components of the examination. This evaluation format is designed for use in conjunction with neurologic evaluation of patients with known or suspected brain lesions and patients with psychiatric involvement. Differential diagnosis of depression, dementia, organic brain disease, and functional disorders is addressed in detail throughout the book. Information is presented in a clear and readable fashion, with current references accompanying each chapter.

The chapters provide detailed information on terminology, common clinical syndromes, suggested test procedures, and clinical implications of test findings in the following areas: history and behavioral observation, consciousness, attention, language, memory, constructional ability, higher cognitive functions (abstract reasoning, problem solving), and cortical functions such as praxis and gnosis.

The authors provide specific definitions of alertness, lethargy, obtundation, stupor, and coma, as well as distinguishing between akinetic mutism, coma vigil, apallic state, persistent vegetative state, and locked-in syndrome in chapter 3. Chapter 5 provides clarification of terminology and localization of lesions that result in various types of aphasia and apraxia, which is helpful in understanding the complexity and the clinical management of these disorders. Detailed descriptions of global, Broca's, Wernicke's, conduction, transcortical, anomic, and subcortical aphasias are provided with accompanying illustrations to detail localization of lesions implicated in these disorders. Chapter 6 consists of a variety of basic memory assessments and includes norms for people ranging in age from 40 to 90 years, as well as guidelines for discriminating between Alzheimer's disease stages I to IV. Test scoring is clarified in chapter 7 with the use of sample visuoconstructive test results, and may provide some insight into occupational therapy test results of visual perceptual skill. Chapter 9 details portions of the test that are related to ideomotor and ideational apraxia, right-left disorientation, and agnosias, with coverage of anatomic pathways and localization of lesions. This chapter may especially be of interest to physical therapists, as testing provides a series of commands and simple tasks with descriptions of common errors in performance that are observed in patients with apraxia. Observations of the ability to perform these tasks and movements provide the "scoring" for these tasks.

Chapter 11 reviews the roles of neuropsychology, speech pathology, psychiatry, social work, and cognitive rehabilitation in the context of a patient with mental status or communication ability changes. Because this information is presented at a relatively basic level, it may be more helpful to inexperienced clinicians than to those clinicians who frequently interact with professionals in these fields.

Key test components are presented for use as a standard assessment tool with an abbreviated version for use in cases where dementia is suspected. Although the authors report a test administration time of 15 to 30 minutes, the potential for a much longer evaluation exists based on the experience of the evaluator and the complexity of patient deficits. The test does not result in a cumulative score of any sort, so that results of each portion of the evaluation must be interpreted separately. The authors do, however, provide a comprehensive framework for evaluation of the important cognitive functions.

The appendixes provide descriptions of test batteries and individual tests that are commonly used in neuropsychology and serve as an excellent reference for interpreting neuropsychological test results. Extensive references are available for further reading for this portion of the text.

Although the mental status evaluation is designed primarily for use by physicians and psychologists, physical therapists may find components of the testing helpful for evaluation of patient mental status, especially where cognitive problems may result in physical manifestations. Although cognitive status is often evaluated in depth by other professionals, the guidelines for judging impairment in cognitive skills may also be helpful for clinicians working with patients with neurologic dysfunction such as stroke and brain injury, as well as for clinicians treating elderly patients where questions about dementia may arise. This book would be a good reference for clinicians who are working with adult patients with central nervous system involvement or organic brain dysfunction.