Cognitive Neurology Continuing Medical Education: History Taking and Bedside Mental Status Examination in a Patient with Dementia

In a patient presenting with forgetfulness, history taking comprises asking questions pertaining to specific cognitive domains namely memory, language, executive function, visuospatial functions, and social cognition to characterize the clinical phenotype. The next step is to administer a standardized screening test for cognitive assessment, namely the Montreal Cognitive Assessment (MoCA)/mini mental status examination (MMSE). These have been validated in five Indian languages. Detailed lobar function tests to assess functions of frontal, temporal, parietal, and occipital lobes namely planning, set-shifting, recent and remote memory, apraxia, agnosia, cortical sensory loss, language, etc., are the final step to identify the possible subtype of dementia. Attention testing with random letter cancellation test must be performed at the outset, as an inattentive patient cannot complete rest of the examination. Clock drawing is a simple bedside test that can assess global cognitive functions by detecting deficits in attention, planning, right-left orientation, constructional ability, visuospatial orientation, and neglect.