Neurological Assessment for Mentally Ill Patients
Comprehensive Nursing Guide
Introduction to Neurological Assessment
Neurological assessment is a critical component of comprehensive care for patients with mental illness. The intricate relationship between neurological function and psychiatric symptoms necessitates a thorough evaluation to distinguish between primary psychiatric disorders and those with neurological origins.
Key Concept
Up to 80% of patients with psychiatric disorders may have neurological abnormalities that are subtle but significant. These “soft signs” can provide diagnostic clues and inform treatment decisions.
For nursing professionals, mastering neurological assessment skills allows for:
- Early detection of neurological complications that may mimic psychiatric symptoms
- Monitoring for medication side effects affecting the nervous system
- Establishing baseline functioning to track disease progression or treatment response
- Identifying emergent neurological conditions requiring immediate intervention
Clinical Relevance
Neurological findings often provide objective data in psychiatric assessment, where many symptoms rely on subjective reporting. This makes the neurological exam an invaluable tool in comprehensive psychiatric care.
Mental Status Examination (MSE)
The mental status examination is the psychiatric equivalent of the physical examination, providing a structured assessment of a patient’s cognitive, emotional, and behavioral functioning at a specific point in time.
| Component | Assessment Focus | Relevance in Mental Illness |
|---|---|---|
| Appearance | Grooming, hygiene, posture, dress, distinguishing features | Reflects self-care abilities; poor hygiene may indicate depression, negative symptoms of schizophrenia, or cognitive impairment |
| Behavior | Psychomotor activity, gestures, eye contact, level of cooperation | Agitation may indicate anxiety or mania; retardation suggests depression; bizarre behaviors may indicate psychosis |
| Mood | Patient’s subjective emotional state | Provides insight into emotional disorders; important to note congruence with affect |
| Affect | Observable emotional expression (range, appropriateness, lability) | Blunted in schizophrenia; labile in bipolar disorder; restricted in depression |
| Speech | Rate, volume, articulation, fluency, quantity | Pressured in mania; poverty of speech in depression; loosening of associations in schizophrenia |
| Thought Process | Organization, logic, and coherence of thoughts | Flight of ideas in mania; thought blocking in schizophrenia; rumination in depression |
| Thought Content | Themes, preoccupations, delusions, suicidal/homicidal ideation | Delusions in psychotic disorders; ruminations in OCD; suicidal thoughts in depression |
| Perceptions | Hallucinations, illusions, depersonalization | Auditory hallucinations in schizophrenia; visual hallucinations often suggest organic etiology |
| Cognition | Orientation, attention, memory, concentration, fund of knowledge | Impaired in delirium, dementia, and severe mental illness; affected by medications |
| Insight | Awareness of illness and need for treatment | Poor insight common in psychotic disorders and associated with treatment non-adherence |
| Judgment | Ability to make sound decisions | Impaired in various psychiatric conditions; crucial for safety assessment |
MSE Mnemonic: “ASEPTIC MAPS”
- Appearance and behavior
- Speech
- Emotional state (mood and affect)
- Perceptions
- Thought process
- Insight and judgment
- Cognition
- Memory
- Attention and concentration
- Preoccupations and content
- Suicidality and homicidality
Important Consideration
The mental status examination provides only a snapshot of the patient’s functioning at a specific moment. Serial assessments over time and in different contexts yield more valuable clinical information.
Comprehensive Neurological Assessment
A thorough neurological assessment helps distinguish between primary psychiatric disorders and those with neurological origins. For psychiatric patients, this assessment should be adapted to their cognitive and emotional state while maintaining comprehensiveness.
Components of Neurological Assessment
Mental Status
Evaluates level of consciousness, orientation, memory, attention, language, and higher cognitive functions.
Cranial Nerves
Assesses function of all 12 cranial nerves to identify focal deficits or medication side effects.
Motor System
Evaluates strength, tone, coordination, and involuntary movements that may indicate medication effects.
Sensory System
Assesses pain, temperature, position sense, and discriminative touch to identify neuropathies.
Reflexes
Evaluates deep tendon reflexes and presence of pathological reflexes indicating CNS pathology.
Cerebellar Function
Assesses coordination, balance, and gait to identify medication effects or comorbid conditions.
Tailoring the Assessment
The extent of neurological assessment in psychiatric patients depends on:
- The patient’s presenting symptoms
- Level of cooperation and cognitive ability
- Medication regimen (especially antipsychotics, mood stabilizers)
- History of neurological conditions or symptoms
- Presence of risk factors for neurological disease
Cranial Nerve Assessment in Psychiatric Patients
Cranial nerve assessment provides valuable information about brainstem function and can identify side effects of psychotropic medications. A thorough baseline assessment is essential, especially before initiating medications that may affect cranial nerve function.
Cranial Nerve Mnemonic: “OOOTTAFVGVAH”
“Oh, Oh, Oh, To Touch And Feel Very Good Velvet, Ah Heaven!”
O = CN I (Olfactory) – Smell
O = CN II (Optic) – Vision
O = CN III (Oculomotor) – Eye movement, pupil constriction
T = CN IV (Trochlear) – Downward & inward eye movement
T = CN V (Trigeminal) – Facial sensation, chewing
A = CN VI (Abducens) – Lateral eye movement
F = CN VII (Facial) – Facial expressions
V = CN VIII (Vestibulocochlear) – Hearing, balance
G = CN IX (Glossopharyngeal) – Taste, swallowing
V = CN X (Vagus) – Swallowing, voice
A = CN XI (Accessory) – Head/shoulder movement
H = CN XII (Hypoglossal) – Tongue movement
Cranial Nerve Assessment Techniques
| Cranial Nerve | Assessment Technique | Psychiatric Significance |
|---|---|---|
| CN I (Olfactory) | Test smell identification with familiar scents (coffee, vanilla) | Rarely tested in psychiatric settings; may be affected in traumatic brain injury, frontal lobe disorders |
| CN II (Optic) | Visual acuity (Snellen chart), visual fields by confrontation, fundoscopic exam | Visual hallucinations, papilledema with increased intracranial pressure; affected by anticholinergic medications |
| CN III, IV, VI (Ocular) | Pupillary response, extraocular movements (“H” pattern) | Nystagmus with lithium toxicity; pupillary dilation with anticholinergics; convergence issues with antipsychotics |
| CN V (Trigeminal) | Facial sensation in 3 divisions, jaw strength, corneal reflex | Facial pain in conversion disorders; masseter spasm in dystonic reactions from antipsychotics |
| CN VII (Facial) | Facial expressions (smile, frown, close eyes, puff cheeks) | Flat affect in depression/schizophrenia; facial asymmetry with tardive dyskinesia; dystonia with antipsychotics |
| CN VIII (Vestibulocochlear) | Hearing assessment, Weber and Rinne tests, balance | Tinnitus with lithium; vertigo with many psychotropics; hearing loss with some antidepressants |
| CN IX, X (Glossopharyngeal, Vagus) | Swallowing, gag reflex, phonation, uvula position | Dysarthria with lithium toxicity; difficulty swallowing with antipsychotic-induced dystonia |
| CN XI (Accessory) | Shoulder shrug against resistance, head turning | Torticollis in antipsychotic-induced dystonia; weakness in catatonia |
| CN XII (Hypoglossal) | Tongue protrusion, movement, and strength | Tongue dyskinesia in tardive dyskinesia; fasciculations with lithium toxicity |
Clinical Alert
Acute onset of cranial nerve deficits warrants immediate medical attention, as they may indicate serious conditions such as stroke, increased intracranial pressure, or neuroleptic malignant syndrome.
Motor Assessment in Psychiatric Patients
Motor assessment is particularly important in psychiatric patients due to the high prevalence of movement disorders related to both primary psychiatric conditions and medication side effects.
Muscle Strength Assessment
Evaluate muscle strength using the Medical Research Council (MRC) scale:
- Grade 5: Normal strength
- Grade 4: Active movement against resistance
- Grade 3: Active movement against gravity
- Grade 2: Active movement with gravity eliminated
- Grade 1: Visible contraction without movement
- Grade 0: No contraction
Test major muscle groups bilaterally and compare side-to-side.
Muscle Tone Assessment
Assess muscle tone through passive movement of extremities, noting:
- Hypotonia: Decreased resistance, “floppiness”
- Hypertonia: Increased resistance to passive movement
- Spasticity: Velocity-dependent resistance (upper motor neuron)
- Rigidity: Constant resistance throughout range (extrapyramidal)
- Cogwheel rigidity: Ratchet-like resistance (Parkinsonism, often medication-induced)
- Lead-pipe rigidity: Consistent resistance (seen in neuroleptic malignant syndrome)
Assessment of Medication-Induced Movement Disorders
Acute Dystonia
Sudden onset of sustained muscle contractions causing abnormal postures
- Torticollis (neck twisting)
- Oculogyric crisis (upward gaze)
- Laryngeal dystonia (life-threatening)
Often occurs within days of starting or increasing antipsychotic dose
Akathisia
Subjective feeling of inner restlessness with objective motor restlessness
- Inability to sit still
- Rocking, pacing, foot-tapping
- Subjective distress
May be mistaken for anxiety or agitation
Parkinsonism
Drug-induced parkinsonism mimicking idiopathic Parkinson’s disease
- Tremor (resting, pill-rolling)
- Bradykinesia (slowed movements)
- Rigidity (cogwheel or lead-pipe)
- Postural instability, shuffling gait
Usually develops within weeks to months
Tardive Dyskinesia
Late-onset, potentially irreversible involuntary movements
- Oro-facial movements (lip smacking, chewing)
- Choreiform movements of extremities
- Torso involvement (rocking, twisting)
Typically develops after months or years of treatment
Neuroleptic Malignant Syndrome
Life-threatening complication of antipsychotic medication
- Severe muscle rigidity
- Hyperthermia
- Autonomic instability
- Altered mental status
Medical emergency requiring immediate intervention
Assessment Tools
Standardized scales for medication-induced movement disorders:
- AIMS (Abnormal Involuntary Movement Scale)
- SAS (Simpson-Angus Scale)
- BARS (Barnes Akathisia Rating Scale)
- DISCUS (Dyskinesia Identification System: Condensed User Scale)
Clinical Pearls for Motor Assessment
- Conduct motor assessments before administering PRN medications that may mask symptoms
- Document baseline findings before initiating psychotropic medications
- Distinguish between primary psychiatric symptoms (e.g., catatonia) and medication side effects
- Remember that movement disorders can worsen with stress or anxiety
- Some abnormal movements may be suppressed voluntarily during examination
Sensory and Reflex Assessment
Sensory Assessment
Sensory assessment in psychiatric patients helps identify peripheral neuropathies from medications, comorbid medical conditions, or substance use. A focused sensory exam can be performed even in patients with limited cooperation.
Primary Sensory Modalities to Assess:
- Pain: Pin prick or fingernail pressure
- Light touch: Cotton wisp or light finger touch
- Temperature: Cold and warm objects (if indicated)
- Vibration: Tuning fork on bony prominences
- Position sense: Movement of distal joints
- Discriminative sensation: Two-point discrimination, stereognosis
Assessment Technique
Test distal to proximal, comparing sides. Have patient close eyes and respond verbally or by pointing to where they feel the sensation.
Psychiatric Considerations:
- Distinguish between true sensory loss and conversion disorder
- Assess for glove-and-stocking distribution (common in medication-induced neuropathies)
- Document sensory changes that may be related to:
- Antipsychotics (peripheral neuropathy)
- Mood stabilizers (paresthesias)
- Substance use (especially alcohol)
- Metabolic disorders (diabetes associated with psychiatric medications)
Clinical Alert
Sensory abnormalities with a clear neuroanatomical distribution warrant further medical evaluation.
Reflex Assessment
Reflex testing provides information about the integrity of the central and peripheral nervous systems and can help identify medication effects or underlying neurological conditions.
| Reflex Type | Assessment Technique | Psychiatric Significance |
|---|---|---|
| Deep Tendon Reflexes (DTRs) | Test biceps (C5-C6), triceps (C7), patellar (L3-L4), and Achilles (S1) reflexes using reflex hammer | Hyperreflexia in lithium toxicity; hyporeflexia in medication-induced peripheral neuropathies |
| Babinski Reflex | Stroke lateral aspect of sole from heel to ball of foot, then across ball of foot | Positive Babinski (upgoing toe) indicates upper motor neuron disease; may be seen in catatonia or NMS |
| Hoffman Reflex | Flick the distal phalanx of middle finger and observe for flexion of thumb and index finger | Positive in upper motor neuron lesions; may be present in medication-induced parkinsonism |
| Glabellar Tap | Tap forehead between eyebrows repeatedly; normal response is blinking that stops after several taps | Persistent blinking (Myerson’s sign) seen in parkinsonism, including medication-induced |
| Jaw Jerk | Place finger on patient’s chin and tap with reflex hammer; observe for jaw closure | Hyperactive in upper motor neuron lesions; may be affected in catatonia |
DTR Grading Mnemonic: “ZATH”
- Zero (0): Absent
- A little (+1): Hypoactive
- Typical (+2): Normal
- Hyperactive (+3/+4): Brisk/Clonus
Neurological Findings in Common Psychiatric Disorders
Understanding the neurological manifestations of psychiatric disorders helps differentiate primary psychiatric symptoms from neurological conditions and medication effects.
Schizophrenia
Common neurological findings:
- Neurological soft signs (NSSs):
- Impaired motor coordination
- Sensory integration deficits
- Primitive reflexes
- Oculomotor abnormalities (smooth pursuit eye movements)
- Stereotypies and mannerisms
- Catatonic features in some cases
NSSs are often present before antipsychotic treatment and may be markers of neurodevelopmental vulnerability
Bipolar Disorder
Common neurological findings:
- During manic episodes:
- Psychomotor agitation
- Reduced need for sleep
- Hyperreflexia
- Pressured speech
- During depressive episodes:
- Psychomotor retardation
- Hyporeflexia
- Slowed speech and thinking
- Soft neurological signs similar to schizophrenia but less severe
Major Depression
Common neurological findings:
- Psychomotor changes:
- Retardation (slowed movements, speech)
- Agitation (restlessness, inability to sit still)
- Cognitive impairment:
- Attention and concentration deficits
- Memory impairment
- Executive dysfunction
- Vegetative signs (sleep, appetite disturbances)
- Pseudodementia in elderly patients
Anxiety Disorders
Common neurological findings:
- Autonomic manifestations:
- Tachycardia, palpitations
- Tremor (fine, postural)
- Hyperventilation
- Diaphoresis
- Hyperreflexia during acute anxiety
- Muscle tension and pain
- Dizziness and light-headedness
- Paresthesias (often related to hyperventilation)
Substance-Related Disorders
Common neurological findings:
- Alcohol-related:
- Cerebellar ataxia
- Peripheral neuropathy
- Wernicke-Korsakoff syndrome
- Stimulant-related:
- Hyperreflexia
- Tremor
- Seizures
- Opioid-related:
- Miosis (pinpoint pupils)
- Respiratory depression
- Hyporeflexia
Neurocognitive Disorders
Common neurological findings:
- Dementia:
- Memory impairment
- Executive dysfunction
- Language deficits
- Visuospatial impairment
- Delirium:
- Fluctuating level of consciousness
- Attention deficits
- Perceptual disturbances
- Autonomic instability
- Asterixis, tremor
Differential Diagnosis: Neurological vs. Psychiatric
Red flags that suggest a neurological basis for psychiatric symptoms:
- Acute onset in a patient without psychiatric history
- Unusual age of onset (very young or elderly)
- Visual hallucinations (more common in organic disorders)
- Focal neurological signs
- Seizure activity or history
- Fluctuating level of consciousness
- Progressive cognitive decline
- Abnormal vital signs
- New headache or change in headache pattern
- Symptoms temporally related to medication changes or substance use
Special Considerations in Neurological Assessment
Assessing the Agitated or Uncooperative Patient
Neurological assessment in agitated or uncooperative patients presents unique challenges but remains essential, especially to rule out neurological causes of agitation.
Approaches to Assessment
- Prioritize essential components (level of consciousness, pupillary response)
- Perform observational assessment (gait, spontaneous movements)
- Incorporate assessment into care activities
- Use brief, simple instructions
- Consider timing assessment when patient is calmer
- Ensure safety for both patient and examiner
Minimally Observable Components
- Level of consciousness
- Pupillary response (using penlight briefly)
- Symmetry of facial movements during speech
- Gross motor movements and symmetry
- Posture and gait (if ambulatory)
- Presence of involuntary movements
- Speech characteristics
Clinical Red Flags
- Asymmetric findings (suggests focal lesion)
- Pupillary abnormalities
- Sudden change in mental status
- New onset seizure activity
- Severe headache with agitation
- Fever with altered mental status
- Recent head trauma
- Neck stiffness
Medication-Related Neurological Effects
Psychotropic medications can cause various neurological effects that require regular monitoring and assessment.
| Medication Class | Common Neurological Effects | Assessment Focus |
|---|---|---|
| Antipsychotics | Extrapyramidal symptoms (EPS), tardive dyskinesia, sedation, anticholinergic effects, neuroleptic malignant syndrome | Regular AIMS assessment, monitoring for tremor, rigidity, akathisia, dystonia; assess for NMS (fever, rigidity, altered mental status) |
| Mood Stabilizers |
Lithium: Tremor, ataxia, dysarthria, cognitive effects, nystagmus Valproate: Tremor, sedation, ataxia Carbamazepine: Diplopia, ataxia, dizziness Lamotrigine: Ataxia, tremor, headache |
Assess coordination, gait, speech, reflexes; monitor drug levels; watch for signs of toxicity |
| Antidepressants |
SSRIs: Headache, tremor, sexual dysfunction, serotonin syndrome TCAs: Anticholinergic effects, sedation, orthostatic hypotension, seizures in overdose SNRIs: Headache, dizziness, hypertension |
Assess for serotonin syndrome (hyperreflexia, clonus, agitation, hyperthermia); monitor blood pressure; assess cognition |
| Anxiolytics |
Benzodiazepines: Sedation, ataxia, coordination problems, cognitive impairment Buspirone: Dizziness, headache |
Assess gait, coordination, and cognition; monitor for signs of toxicity or withdrawal |
| Stimulants | Headache, tremor, increased reflexes, tics, insomnia, appetite suppression | Monitor vital signs, weight, sleep patterns; assess for emergence or worsening of tics |
Serotonin Syndrome Mnemonic: “FEVER CATS”
F = Fever
E = Encephalopathy (confusion)
V = Vital sign abnormalities
E = Excitation (agitation)
R = Reflexes (hyperreflexia)
C = Clonus
A = Autonomic instability
T = Tremor
S = Shivering, diaphoresis
Important Consideration
Neurological symptoms in psychiatric patients should never be automatically attributed to their psychiatric condition or medication. New-onset neurological findings warrant thorough medical evaluation.
Documentation and Communication
Proper documentation of neurological findings in psychiatric patients is essential for continuity of care, establishing baselines, monitoring changes, and ensuring appropriate interventions.
Principles of Effective Documentation
Be Objective
Document observable findings rather than interpretations:
Instead of: “Patient has tardive dyskinesia”
Document: “Patient exhibits repetitive, involuntary lip-smacking movements and tongue protrusion observed throughout the assessment”
Be Specific
Include details about frequency, duration, and severity:
Instead of: “Patient is tremulous”
Document: “Fine, bilateral hand tremor present at rest, increases with intentional movement, interferes with ability to hold cup without spilling”
Be Comprehensive
Include all components of the assessment:
- Mental status
- Cranial nerve function
- Motor system
- Sensory function
- Reflexes
- Coordination and gait
- Use standardized scales where appropriate (AIMS, GCS)
Sample Documentation Templates
Basic Neurological Assessment Documentation
Neurological Assessment:
Mental Status: Alert and oriented to person, place, time, and situation. Speech clear and coherent. Follows complex commands without difficulty.
Cranial Nerves: CN II-XII grossly intact. PERRLA. EOMs intact without nystagmus. Facial movement symmetrical. Hearing intact bilaterally. Tongue midline without fasciculations.
Motor: Full strength 5/5 in all extremities. No tremor, rigidity, or involuntary movements noted. Normal tone.
Sensory: Light touch intact in all extremities. No report of numbness or tingling.
Coordination: Finger-to-nose and heel-to-shin testing WNL bilaterally. Rapid alternating movements intact.
Gait: Steady, with normal base, arm swing, and turning.
Reflexes: DTRs 2+ and symmetrical in upper and lower extremities. Plantar reflexes downgoing bilaterally.
Documentation for Patient with Abnormal Findings
Neurological Assessment:
Mental Status: Alert but disoriented to date (states year is 2010). Attention fluctuates during conversation. Unable to recall 3/3 objects after 5 minutes.
Cranial Nerves: CN II-XII assessed. Pupils equal at 4mm, sluggish reaction to light bilaterally. EOMs intact. Facial asymmetry noted with slight drooping of right corner of mouth. Hearing grossly intact. Gag reflex present.
Motor: Strength 4/5 in right upper and lower extremities, 5/5 on left side. Cogwheel rigidity noted in right arm. Fine resting tremor observed in right hand. AIMS performed: score 8 (orofacial movements present at rest).
Sensory: Decreased sensation to light touch in glove distribution bilaterally to mid-forearm. Reports pins and needles sensation in fingertips bilaterally.
Coordination: Mild dysmetria on right with finger-to-nose testing. Rapid alternating movements slowed on right.
Gait: Shuffling gait with decreased arm swing on right. Mild postural instability with retropulsion on pull test.
Reflexes: DTRs 3+ in lower extremities, 2+ in upper extremities. No ankle clonus. Plantar reflexes downgoing bilaterally.
Critical Findings Requiring Immediate Action
Report Immediately to Provider:
- Acute change in level of consciousness
- New onset focal neurological deficits
- Suspected neuroleptic malignant syndrome (fever, rigidity, altered mental status)
- Severe dystonic reactions, especially affecting the airway
- Signs of increased intracranial pressure (severe headache, vomiting, altered mental status, pupillary changes)
- Seizure activity
- Signs of serotonin syndrome (hyperthermia, agitation, hyperreflexia, clonus)
- Suspected stroke (facial droop, arm weakness, speech disturbance)
Summary and Key Points
Key Takeaways
Importance of Neurological Assessment
- Neurological and psychiatric systems are intricately connected
- Neurological findings can differentiate psychiatric from neurological disorders
- Establishes baseline functioning before starting medications
- Monitors for medication side effects and complications
- Identifies emergent conditions requiring immediate intervention
Components to Prioritize
- Mental status examination (orientation, attention, memory)
- Cranial nerve function (especially oculomotor)
- Motor system assessment (strength, tone, involuntary movements)
- Coordination and gait
- Reflexes
- Sensory function (when indicated)
Special Considerations
- Tailor assessment to patient’s mental state and cooperation level
- Document objective findings comprehensively
- Use standardized scales (AIMS, SAS, BARS) for medication monitoring
- Recognize medication-induced neurological effects
- Be aware of cultural and educational influences on assessment findings
Red Flags for Immediate Action
- New-onset focal deficits
- Acute change in mental status
- Signs of increased intracranial pressure
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Status epilepticus
- Acute dystonic reactions affecting respiration
Final Thoughts
The neurological assessment of psychiatric patients requires a systematic approach, clinical judgment, and understanding of the complex interplay between neurological and psychiatric conditions. Regular neurological assessment by nursing staff forms the cornerstone of early detection of complications and ensures optimal patient outcomes.
References and Resources
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., Text Revision). American Psychiatric Association Publishing.
- Faber, R. A. (2009). The neuropsychiatric mental status examination. Seminars in Neurology, 29(3), 185–193.
- Martin, D. C., & Flemming, K. C. (2013). The mental status examination in neurology (4th ed.). F.A. Davis Company.
- Olshaker, J. S., Brown, M. M., Arthur, D. C., & Jerrard, D. A. (2014). The psychiatric assessment and brief neurological assessment in the emergency department. Psychiatric Clinics of North America, 37(1), 137–147.
- Sanders, R. D., & Keshavan, M. S. (2002). The neurologic examination in adult psychiatry: From soft signs to hard science. Journal of Neuropsychiatry and Clinical Neurosciences, 14(1), 39–48.
- Strub, R. L., & Black, F. W. (2000). The mental status examination in neurology (4th ed.). F.A. Davis Company.
- Tanner, J., & Docherty, K. (2015). The neurologic assessment for psychiatry. Current Psychiatry, 14(4), 33–45.
- Torrey, E. F. (2002). Studies of individuals with schizophrenia never treated with antipsychotic medications: A review. Schizophrenia Research, 58(2–3), 101–115.
Recommended Assessment Tools
- Abnormal Involuntary Movement Scale (AIMS)
- Simpson-Angus Scale (SAS) for Extrapyramidal Side Effects
- Barnes Akathisia Rating Scale (BARS)
- Mini-Mental State Examination (MMSE)
- Montreal Cognitive Assessment (MoCA)
- Glasgow Coma Scale (GCS)
- NIH Stroke Scale (NIHSS)
- Neurological Evaluation Scale (NES) for soft signs