[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Nervous system](https://durgical.com/en/clinical-exam/#a-neuro) › Mental status: orientation, attention and screening tests [Clinical exam](https://durgical.com/en/clinical-exam/) · [Nervous system](https://durgical.com/en/clinical-exam/#a-neuro) # 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](https://durgical.com/en/anatomy/superior-frontal-gyrus/) · [Temporal lobe](https://durgical.com/en/anatomy/middle-temporal-gyrus/) · [Parietal lobe](https://durgical.com/en/anatomy/superior-parietal-lobule/) ## Key points - Consciousness and attention first; an inattentive patient fails every other test. - Attention: serial 7s from 100, spelling 'WORLD' backwards or the months of the year backwards. - Delirium: acute onset, fluctuating course and inattention, with disorganised thinking or altered consciousness; it is a medical emergency. - Dementia: progressive cognitive decline over months or years with attention relatively preserved early on. - The MMSE and the MoCA are both scored out of 30; the MoCA is more sensitive for mild impairment. - Loss of orientation to person appears only in severe states. ## 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. ## Memory aid 'Awake, attentive, oriented, remembers, speaks': if the first fails, the rest do not count. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/mental-status-orientation-attention-and-screening-tests/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Frontal lobe](https://durgical.com/en/anatomy/superior-frontal-gyrus/) - [Temporal lobe](https://durgical.com/en/anatomy/middle-temporal-gyrus/) - [Parietal lobe](https://durgical.com/en/anatomy/superior-parietal-lobule/) ## Related - [The neurological examination: order and screening exam](https://durgical.com/en/clinical-exam/the-neurological-examination-order-and-screening-exam/) - [Recognising a stroke: BE-FAST and the NIH Stroke Scale](https://durgical.com/en/clinical-exam/recognising-a-stroke-be-fast-and-the-nih-stroke-scale/) - [Intracranial hypertension syndrome](https://durgical.com/en/clinical-exam/intracranial-hypertension-syndrome/) ## Related conditions - [Delirium](https://durgical.com/en/conditions/delirium/) - [Dementia (major neurocognitive disorder)](https://durgical.com/en/conditions/dementia/) - [Alzheimer disease](https://durgical.com/en/conditions/alzheimer-disease/) - [Hepatic encephalopathy](https://durgical.com/en/conditions/hepatic-encephalopathy/) - [Wernicke encephalopathy (thiamine deficiency)](https://durgical.com/en/conditions/wernicke-encephalopathy/) [← All of the clinical exam](https://durgical.com/en/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](https://www.msdmanuals.com/professional/neurologic-disorders/neurologic-examination/how-to-assess-mental-status) (MSD Manual Professional Edition, 2024); [16.2 The Mental Status Exam](https://openstax.org/books/anatomy-and-physiology-2e/pages/16-2-the-mental-status-exam) (OpenStax, Anatomy and Physiology 2e, 2022); [Delirium](https://medlineplus.gov/ency/article/000740.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [26.2 Physical Assessment - Clinical Nursing Skills](https://openstax.org/books/clinical-nursing-skills/pages/26-2-physical-assessment) (OpenStax, 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/mental-status-orientation-attention-and-screening-tests/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/mental-status-orientation-attention-and-screening-tests/