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Orientation is the patient’s ability to describe the time, place, person and situation. It is highly integrated throughout the cortex, as are most of the cognitive functions tested in this portion of the MSE. The six general areas of the brain listed below link to associated cognitive assessments. In all of the categories, a patient’s correct responses suggest adequate functioning of that area, but incorrect responses cannot confirm pathology in that area. Other factors, such as pain, cultural/educational background and sensory deficits, may affect a patient's ability to perform the task.
a. Attention/Concentration - Serial 7’s, WORLD backwards, 5 digits forward and 4 digits reverse.
b. Judgment – Manifestations of behavior that are harmful to the patient and contrary to acceptable behaviors in the culture. May test with imaginary situation, i.e. What would you do if you found a stamped, addressed letter on the street?
c. Insight: Degree of awareness and understanding the patient has that he or she is ill (denial?)
d. Intellectual Functioning: Estimate of overall fund of knowledge
e. Abstraction: Proverb interpretation (i.e. a rolling stone gathers no moss), similarities between objects in the same class, ability to discuss emotions and see their connectivity with content of thought.
1. Remote: Past historical events or data that can be verified i.e. address, SS#, DOB.
2. Recent: Recall of past few days, yesterday’s events, meals eaten today.
3. Immediate: Recall 3 words at 5 mins., recall names of people in immediate environment i.e. M.D.
1. Fluency: Latency of response, excessive pauses.
2. Comprehension: Ask to do 2-3 step process.
3. Repetition: “No ifs, ands, or buts” (left perisylvian fissure lesion).
4. Naming: “Ability to identify and name objects presented”
5. Reading comprehension
7. Prosody: Affective intonations that accompany language (right frontal cortical lesions, PDD).
Drawing clock face, copying 2 and 3 dimensional figures (overlapping pentagons)
Naming objects, colors or recognition of faces.