During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking
with you. You notice some confabulation during various aspects of memory testing, so you
perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in
orientation, registration, attention & calculation, and recall. The score suggests moderate
MENTAL STATUS EXAM
Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye
contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor
movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is
restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought
processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented
to time and event [he reports that he thought he was coming to lunch but “wound up here”-
referring to your office, at which point he begins to laugh]. Insight and judgment are impaired.
Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical
interview and walking towards the door. When you asked where he was going, he stated that he
did not know. Mr. Akkad denies suicidal or homicidal ideation.
Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)