From the Guidelines
The Central Nervous System (CNS) examination follows a systematic approach that includes mental status assessment, cranial nerve evaluation, motor system testing, sensory examination, reflex testing, coordination assessment, and gait analysis, as recommended by the Alzheimer's Association clinical practice guideline for the diagnostic evaluation of suspected Alzheimer's disease and related disorders 1.
Key Components of the CNS Examination
- Mental status examination to evaluate consciousness level, orientation, memory, language, and cognitive function
- Cranial nerve evaluation to assess functions like visual acuity, eye movements, facial sensation, hearing, and swallowing
- Motor system testing to assess bulk, tone, power, and look for abnormal movements
- Sensory examination to evaluate light touch, pain, temperature, vibration, and proprioception in all limbs
- Reflex testing, including deep tendon reflexes and plantar responses
- Coordination assessment through finger-nose, heel-shin tests, and rapid alternating movements
- Gait analysis, including tandem walking and Romberg test
Use of Validated Assessment Instruments
The use of validated brief cognitive assessment tests, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA), is recommended to detect cognitive impairment or dementia 1. These tests can be used in primary care settings and can help identify patients who require further evaluation or referral to a specialist.
Neurological Examination and Stroke Scale Scores
In cases of suspected stroke, the use of a standardized stroke scale, such as the National Institutes of Health Stroke Scale (NIHSS), is recommended to quantify the degree of neurological deficit and facilitate communication between healthcare professionals 1. The NIHSS is an 11-part scale that measures the neurologic examination in a codified manner and can help identify patients who are eligible for various interventions and predict potential complications.
From the Research
CNS Examination Format
The format for a CNS (Central Nervous System) examination is not explicitly stated in the provided studies. However, some studies mention the use of certain assessment tools, such as:
- Mini-Mental State Examination (MMSE) 2
- Cohen-Mansfield Agitation Inventory (CMAI) 3
- Neuropsychiatric Inventory and Behavioral Pathology in Dementia scales 3
- Neurobehavioral Rating Scale (NBRS) 3
- UKU side effect scale total score 3
Assessment Tools
These assessment tools are used to evaluate various aspects of cognitive and neuropsychiatric symptoms in patients with dementia, including:
- Cognitive function
- Agitation
- Psychosis
- Behavioral symptoms
- Neuropsychiatric symptoms
Key Points
Some key points to note about the CNS examination format include:
- The use of standardized assessment tools to evaluate cognitive and neuropsychiatric symptoms
- The importance of considering the patient's dementia subtype and individual needs when selecting assessment tools
- The need for further research to determine the efficacy and safety of various treatments for agitation and psychosis in dementia 4, 3