Mental status: orientation, attention and screening tests !

Exam technique

An assessment of the patient's consciousness, attention, orientation, memory and language.

Updated 2026-11-01

See it in 3D: Frontal lobe · Temporal lobe · Parietal lobe

What it is

The mental status exam describes how the brain is working right now: level of consciousness, attention, orientation, memory, language and judgement. It always starts with consciousness and attention, because if those fail the other tests cannot be interpreted. Telling delirium (acute and fluctuating) from dementia (chronic) is one of its most important uses.

Landmark anatomy

Consciousness: the reticular activating system of the brainstem and its projections to the thalamus and cortex.
Episodic memory: hippocampus and medial temporal lobe.
Language: Broca area (frontal, expression) and Wernicke area (temporal, comprehension) of the dominant hemisphere.
Attention, judgement and planning: the prefrontal cortex.

Technique, step by step

Level of consciousness: describe the response (opens eyes to voice, to touch or to pain) rather than relying on words such as 'drowsy'.
Attention: ask the patient to repeat three words at once, to subtract 7 from 100 serially or to spell 'WORLD' backwards.
Orientation: 'Could you tell me your name? What is today's date? Where are we?'
Recent memory: give three words and ask for them again after 3 to 5 minutes.
Language: note fluency, ask the patient to name objects, repeat a sentence and follow a three-step command.
Verbal fluency: name as many animals as possible in one minute.
Visuospatial and executive: copy a drawing or draw a clock showing a given time.
Record mood, thought content, judgement and insight.

Abnormal findings

Expressive (Broca) aphasia: sparse, effortful speech with preserved comprehension; suggests a dominant frontal lesion.
Receptive (Wernicke) aphasia: fluent but meaningless speech with poor comprehension; suggests a dominant temporal lesion.
Acute, fluctuating confusion, worse at night: delirium from infection, drugs, withdrawal, electrolyte disorders or hypoglycaemia.
Progressive forgetting of recent events with orientation preserved early: dementia, such as Alzheimer disease.

Common errors

Interpreting tests without allowing for schooling, language, or hearing or vision loss.
Blaming confusion on age without looking for delirium.
Assessing a fluctuating patient only once; delirium can be missed during a lucid moment.

Test yourself

Think of the answer, then tap the question to see it.

Why is attention tested before memory?

An inattentive patient cannot register information and will fail memory and nearly every other test; inattention is also the core feature of delirium.

Which features separate delirium from dementia?

Delirium starts over hours or days, fluctuates and impairs attention and consciousness; dementia progresses over months or years with attention relatively preserved at first.

What kind of aphasia does a Wernicke area lesion cause?

A fluent, receptive aphasia: the patient speaks fluently but with meaningless words and understands poorly what is said.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: How To Assess Mental Status (MSD Manual Professional Edition, 2024); 16.2 The Mental Status Exam (OpenStax, Anatomy and Physiology 2e, 2022); Delirium (MedlinePlus, U.S. National Library of Medicine, 2024); 26.2 Physical Assessment - Clinical Nursing Skills (OpenStax, 2024).

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Representative model, for educational purposes only.