The Mental Status Examination in Neurology

The basic purpose and scope of this book have not changed since the first edition was published in 1977. In the intervening years, we have gained con-siderable additional clinical experience with the mental status examination and have standardized most of its sections. Some of the standardized items have been compared with the objective data generated from formal neuro-psychological tests. These comparisons have been very rewarding because the mental status examination has been proved an accurate and valid method for identifying and diagnosing organic brain disease as well as for describing relative levels of functioning. Age-related norms are presented for most aspects of the examination. These data are important because we have found that our patients aged 70 and older do perform less adequately on some of the critical items, especially new learning, than do the younger patients. This difference is important to take into account when assessing the elderly for early demen-tia. False positive results can occur and must be minimized. In the first edition, we assured the reader that after reading and using the book he or she would be able to perform a brief screening examination. It has been suggested that we provide more concrete guidelines for tailoring the examination for brief administration. Therefore, in the summary section of this edition, we have included some ways to use the examination as a screening procedure, particularly in the extremely important areas of diag-nosing dementia and differentiating between organic and functional disor-ders. A shortened form of the examination is presented, with standardization for normals of various ages and for patients with Alzheimer's disease. We have updated the references in all chapters; this is particularly the case in those sections in which new studies have refined the neuroanatomic and neuropsychological aspects of cognitive functions. The section on neu-ropsychological testing has been fully revised to include a survey of the most commonly used tests, to drop some tests that have fallen from general use, vii viii THE MENTAL STATUS EXAMINATION IN NEUROLOGY and to make this section more clinically relevant to both physicians and other health-care providers and to psychologists. In general, we feel that the earlier editions were good and have dem-onstrated their value in widespread clinical use. With each edition we have tried to refine both the process of the examination and its clinical usefulness. We hope this text will prove as useful to others who are interested in neu-robehavior as it has been to our students, residents, and professional colleagues. RL STRUB, MD FW BLACK, PhD NEW ORLEANS, LA