This is particularly true for scales with shorter assessment times that are optimized for detecting dementia rather than MCI. However, performance in the unimpaired range on these scales does not rule out the possibility of more subtle (yet still meaningful) cognitive deficits that might be detected through more comprehensive neuropsychological testing. "Normal" performance – Overall, screening mental status scale scores in the unimpaired range (particularly for patients with demographic profiles similar to the applicable validation cohorts) should be considered reassuring to patients and their families and caregivers and can be used to support a decision not to pursue further testing.Mental status scales are also used in other populations that are at higher risk for cognitive deficits, including patients with multiple sclerosis, traumatic brain injuries, and psychiatric disorders. (See "Comprehensive geriatric assessment", section on 'Cognition'.) Recommendations for screening for cognitive impairment and dementia in older patients are discussed in detail separately. However, many expert groups explicitly do not recommend screening for dementia in otherwise asymptomatic patients, and some actively recommend against such assessments in that patient population. Because routine medical history and physical examinations in this patient population may be insufficient for identifying significant cognitive impairment, screening for cognitive impairment with a mental status scale is suggested as an additional approach. Assessment for cognitive impairment is a required component of the Medicare Annual Wellness Visit for older adults. Indications - Mental status scales are perhaps most frequently used to screen older adult patients for mild cognitive impairment (MCI) or dementia. Screening for cognitive impairment and dementia - The mental status scales that are typically used for screening can be administered in routine clinical appointments and over shorter durations (≤30 minutes) than formal neuropsychological testing, but are more limited in both the breadth and depth of assessment. (See "Evaluation of cognitive impairment and dementia".) Other aspects of the evaluation of patients with cognitive disorders are also discussed separately. (See "The mental status examination in adults".) The extended mental status examination is presented separately. This topic will specifically review the use of mental status scales, with a particular focus on their use in older adult patients. Referral to neuropsychology often occurs in clinical settings where screening scales and/or the extended mental status examination are not sufficiently conclusive to render a diagnosis. Neuropsychological testing can last up to several hours and can be divided across multiple visits. Formal neuropsychological testing incorporates the most detailed assessments with normative values that can account for a wide range of demographic factors.This assessment can be invaluable in assessing the overall pattern of performance, determining the cognitive domains and brain regions affected, and formulating a differential diagnosis of underlying neuropathology. The experienced examiner can complete this assessment in a single clinical encounter. The extended mental status examination or neurobehavioral status examination includes more detailed assessments and observations regarding a broader range of cognition and behavior and may take 30 minutes to several hours to perform.Compared with neuropsychological testing, mental status scales are limited in relative lack of standardization, normative data, and, in many cases, validation. While they are particularly useful for identifying cognitively impaired individuals who might benefit from more extensive assessments, they provide less insight into which brain areas might be affected or potential underlying etiologies. These tests are designed to efficiently distinguish patients with impaired cognition. Mental status scales are short instruments (≤30 minutes) that assess memory and/or other cognitive domains, with structured administration and scoring and predetermined cutoff scores.It can be divided into three levels of rigor: The cognitive assessment portion of the mental status examination is designed to distinguish between normal and abnormal performance arising across a range of different conditions. While technological advances in neuroimaging have enabled the direct observation of the brain with regards to structure, blood flow, metabolic function, and deposition of abnormal proteins, mental status examination remains critical for clinical diagnosis, patient care, and research. INTRODUCTION - The mental status examination is an important tool for assessing cognitive and behavioral functions.
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