1. Mental Status and Neurological Techniques
Chapter 20
Mental Status and
Neurological Techniques

2. Competencies
Discuss the divisions of the nervous system and their functions.
Relate blood flow to the brain to the functional area supplied.
Describe the characteristics of the most common neurological complaints.
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3. Competencies
Perform a mental status assessment and document the results.
Examine the neurological system in a systematic manner and document the results.
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4. Competencies
Explain the pathophysiology of any abnormal results obtained.
Document a complete health history as it relates to the neurological system.

5. Nervous System Purpose Tasks
Controls all body functions and thought processes
Tasks
Maintains homeostasis
Receives, interprets, reacts to stimuli
Controls voluntary and involuntary processes

6. Anatomy and Physiology
Protective layers
Scalp
Skull
Meninges
Dura mater
Arachnoid mater
Pia mater

7. Central Nervous System (CNS)
CNS is composed of the brain and spinal cord
Cerebrum
Right and left hemispheres
Connected by the corpus callosum
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8. Central Nervous System
Cerebral cortex
Outermost layer of cerebrum
Contains gray matter
Higher cognitive functioning
Memory storage and recall
Sensation
Vision, hearing, motor function

9. Lobes of the Cerebrum Frontal Parietal Higher intellectual function
Speech production
Ipsilateral motor control
Parietal
Somatic sensory
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10. Lobes of the Cerebrum Temporal Occipital Hearing Memory
Speech perception
Occipital
Vision
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11. Lobes of the Cerebrum Limbic Anatomically part of the temporal lobe
Emotion and self-preservation

12. Brain Diencephalon Cerebellum Thalamic structures
Body temperature regulation, pituitary hormone control, autonomic nervous system responses
Cerebellum
Movement, posture, and equilibrium
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13. Brain Brain stem Respiratory and cardiac regulation Level of awareness
Reticular activating system
Includes midbrain, pons, medulla oblongata

14. Spinal Cord Gray matter White matter Dorsal horn Ventral horn
Sensory (afferent) neurons
Ventral horn
Motor (efferent) neurons
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15. Spinal Cord Motor pathways of CNS Sensory pathways
Corticospinal or pyramidal tract
Extrapyramidal tract
Cerebellum
Sensory pathways
Spinothalamic tracts
Posterior column

16. Blood Supply Internal carotid arteries Vertebral arteries
Circle of Willis

17. Peripheral Nervous System
31 pairs of spinal nerves
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
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18. Peripheral Nervous System
Dorsal (afferent) root
Ventral (efferent) root
Dermatomes

19. Cranial Nerves 12 pairs Motor, sensory, or both Olfactory (I)
Optic (II)
Oculomotor (III)
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20. Cranial Nerves Trochlear (IV) Trigeminal (V) Abducens (VI)
Facial (VII)
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21. Cranial Nerves Acoustic (VIII) Glossopharyngeal (IX) Vagus (X)
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22. Cranial Nerves
Spinal accessory (XI)
Hypoglossal (XII)

23. Autonomic Nervous System
Functions without voluntary control to maintain homeostasis
Sympathetic nervous system
Parasympathetic nervous system

24. Reflexes Specific response to adequate stimulus Monosynaptic
Polysynaptic
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25. Reflexes Classes Muscle stretch or deep tendon reflexes
Superficial reflexes
Pathological reflexes

26. Health History Age Gender Early adulthood Middle adulthood
Older adulthood
Gender
Female
Male
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27. Health History Race African-American Asian or Pacific Islander
Hispanic
Caucasian

28. Common Chief Complaints
Headache
Seizure
Syncope
Tremor
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29. Common Chief Complaints
Pain
Paresthesia
Disturbances in gait
Visual changes
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30. Common Chief Complaints
Vertigo
Memory disorders
Difficulty with swallowing or speech

31. Characteristics of Chief Complaints
Quality
Quantity
Associated manifestations
Aggravating factors
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32. Characteristics of Chief Complaints
Alleviating factors
Setting
Timing

33. Past Health History Medical history Surgical history Medications
Neurologic specific
Non-neurologic specific
Surgical history
Medications
Antidepressants, narcotics, antianxiety, and antiseizure medications
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34. Past Health History Communicable diseases Injuries and accidents
Family health history
Congenital defects
Headaches
Alzheimer’s disease

35. Social History Alcohol, tobacco, drug use Sexual practice
Travel history

36. Characteristics of Chief Complaints
Work and home environment
Hobbies and leisure activities
Stress

37. Health Maintenance Activities
Sleep
Diet
Exercise
Use of safety devices
Health checkups

38. Assessment Equipment Pencil and paper Cotton wisp and applicators
Penlight
Tongue blade
Tuning fork
Reflex hammer
Sterile needle or safety pin
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39. Assessment Equipment (cont’d) Small objects
Vials with odorous materials
Vials with hot and cold water
Vials with solutions for tasting
Vision chart
Pupil gauge
Single fiber monofilament
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40. Assessment General approach
Greet the patient and explain the examination
Provide a warm, quiet, well-lit environment
Assess mental status first, then request patient to change into a gown

41. Mental Status Physical appearance and behavior Posture and movements
Dress, grooming, and hygiene
Facial expression
Affect
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42. Mental Status Communication Articulation, fluency, rate of speech
Ability to read, write, follow simple commands
Assess for aphasia, dysarthria, dysphonia, apraxia, agraphia
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43. Mental Status Level of consciousness Cognitive abilities and mentation
Glasgow Coma Scale
Cognitive abilities and mentation
Assess attention, memory, judgment, insight, spatial perception, calculation, abstraction, thought processes, thought content

44. Mental Status: Normal Findings
Posture erect, gait smooth, body movements symmetrical
Clean, well-groomed, clothing appropriate for age and weather
Facial expressions symmetrical and appropriate to conversation content
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45. Mental Status: Normal Findings
Affect appropriate to situation and cultural norms
Able to produce spontaneous, coherent speech
Alert, oriented to person, place, time
Intact cognitive abilities

46. Sensory Assessment Exteroceptive sensation Proprioceptive sensation
Light touch, superficial pain, temperature
Proprioceptive sensation
Motion, position, vibration, extinction
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47. Sensory Assessment Cortical sensation
Stereognosis, graphesthesia, discrimination, extinction

48. Sensory Assessment: Normal Findings
Able to accurately perceive light touch, superficial pain, temperature
Able to identify changes in position of body, vibration, common objects
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49. Sensory Assessment: Normal Findings
Cranial nerves intact
Cerebellar function intact, gait stable
Deep tendon reflexes present and grading 2+ bilaterally

50. Motor System Extrapyramidal rigidity Decerebrate Decorticate
Pronator drift
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51. Motor System
Cerebellar function
Coordination
Station
Gait

52. Reflexes Deep tendon Grading scale 0–4+ 0 = absent
+ (1+) = present but diminished
++ (2+) = normal
+++ (3+) = mildly increased but not pathological
++++ (4+) = markedly hyperactive, clonus may be present
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53. Reflexes Deep tendon (cont’d) Compare right to left
Use a stick figure to document reflexes
Assessing specific reflexes
Brachioradialis
Biceps
Triceps
Patellar
Achilles
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54. Reflexes Superficial Assessing specific reflexes Abdominal Plantar
Cremasteric
Bulbocavernosus
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55. Reflexes Pathological
Abnormal findings in adults and children are not assessed unless the patient’s condition warrants it
Glabellar
Clonus
Babinski

56. Advanced Techniques Doll’s eyes phenomenon Romberg test
Meningeal irritation
Nuchal rigidity
Kernig’s sign
Brudzinski’s sign