Clinical Management of Variables Affecting Mental Status Assessment in Moderately to Severely Impaired Elderly Brain Damaged Persons

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Abstract
This paper explores sources of variation stemming from the patient, the environment, and from the clinician which can negatively influence the validity of the mental status examination in the moderately to severely impaired elderly patient. Examples are also provided for coping with variation such as reduced levels of consciousness, hospital environs, and modification of metabolic and nutritional status. Sophistication in training and attitudes of the mental status examiner in dealing with the many faces of dementia are emphasized. The exposition suggests a need for: 1) further laboratory testing of methods for enhancing examinability of such patients; 2) brief and valid quantitative mental status examinations; and 3) a new view of standardization of mental status instruments to allow assessment of the elderly in the appropriate environmental context.

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