Assessment of Behavior

The neurological examination begins with an assessment of the patient's ability to comprehend speech, follow simple instructions, perform complicated cognitive tasks, and perceive and identify sensory stimuli. The patient's spontaneous remarks and movements as well as those made in response to commands are evaluated for any digressions from expected norms of behavior, noting indications of the patient's orientation to person, place, time, and circumstances. Disturbances in mood and affect emerge during conversation. Engaging the patient in a conversation often reveals difficulties with attention if he or she is unable to focus well enough to follow the verbal exchange. Language comprehension is assessed by having the patient repeat simple phrases and follow simple commands. Expressive language is assessed by listening to the patient's free speech for dysarthria, paraphasias, and neologisms. A clinical test of attention and mental control is to ask the patient to spell a word backward or to recite lists of words or numbers backward. Memory can be assessed through the details a patient is able to recall concerning medical history or through brief clinical assessment. Visuospatial and constructional ability can be assessed by having the patient draw the face of a clock with the hands set at a particular time.

Although these brief tests often reveal gross cognitive deficits associated with severe acute intoxication, acute toxic encephalopathy, and/or severe chronic toxic encephalopathy, patients with less severe or mild chronic toxic encephalopathy may present with subtle performance deficits that require formal neuropsychological assessment to detect and document. All patients exposed to neurotoxic chemicals who present with complaints of central nervous dysfunction should have formal neuropsychological testing to ascertain whether they are suffering from toxic encephalopathy.

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