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CHAPTER 1 Neurological history and examination
Box 1.1 Example of passage for reading Most visitors to our park are under the impression that the best way to prevent being injured in a stampede is simply to avoid large herds of grazing animals. Unfortunately, smaller groups of animals may be just as dangerous. As few as three bison, if startled or upset, could trample upon a traveler and cause serious harm. While you are here, feel free to hike the park’s many paths and enjoy the rustic beauty of the Michigan countryside. However, if you see a group of three or more bison, I would encourage you to back away slowly.
Figure 1.9 Overlapping pentagons from the mini-mental state examination (MMSE).
The mini-mental state examination (MMSE) Commonly used bedside test (see Table 1.10).1 Caveats include the following: • Take into account age, education, and culture. • Insensitive to focal deficits, especially frontal lobe • Cut-off score is 24/30, but patients with superior background IQ may perform well despite significant cognitive impairment. • The MMSE tests mu tiple areas of cognition but does not adequately evaluate executive function (judgment, insight). The Montreal Cognitive Assessment (MoCA) is probably a better screening tool for dementia. However, the MMSE is used more commonly, so the scores may have more meaning to other practitioners who see the patient.
1 Folstein, MF, Folstein, S, McHugh, PR (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res 12:189–198.