Assessment of Language
April 1st, 2023
Overview
Language assessment is a crucial element of the mental status examination, providing insight into a patient's cognitive and communicative abilities. Key aspects of evaluating language include comprehension, word repetition, object naming, reading, and writing.
Comprehension
Written comprehension
- Show a written instruction, e.g.
Simple Verbal Comprehension
- Name objects such as pen, watch and key, and ask the patient to point to them.
Complex Verbal Comprehension
- Ask the patient to take a piece of paper into their right hand, fold it in half and then place the paper onto the floor.
Conceptual comprehension
- Show the patient the same pen, watch and key as above and ask them to point to the object that shows the passage of time.
Word Repetition
How to Assess
Ask the patient to repeat back words or sentences of increasing complexity.- Orange
- Watch
- Hippopotamus
- Aubergine
- Emerald
- Perimeter
- No ifs, ands or buts
- British Constitution
- The orchestra played and the audience applauded
Significance
- Patients may not be able to repeat the terms back due to dysarthria, dysphasia, confusion or poor compliance.
Object Naming
Items around the room - point to objects and ask the patient to name them. Avoid frequently named items such as pen and watch - ask them to name objects such as cufflink or stethoscope.
Pictures of items - show drawings of objects and ask the patient to name them.
The Boston Naming Test (BNT) is an example of a tool used to assess word retrieval in brain damaged patients.
Assessment of Reading
Show the patient a list of words and ask them to read the words out loud, or ask them to read a few sentences from a newspaper.
Causes of Disordered Reading
- Pure alexia - reading of words letter-by-letter.
- Surface dyslexia - ability to phonetically sound out words (breed, steam), but difficulty reading words with irregular spelling (debt, colonel, broad, steak).
- Phonological dyslexia - inability to read non-words (neg, bluck, deak) with otherwise normal reading of words.
- Deep dyslexia - semantic errors (e.g. reading the word 'table' as 'chair' or 'street' as 'road'), and inability to read plausible non-words (neg, bluck, deak).Stroke, traumatic brain injury
- Neglect dyslexia - the patient omits or substitutes part of a word, especially at the beginning of the word. For example, island / land or fish / dish.Dominant hemispheric damage
Note
- The term 'dyslexia' is colloquially used to denote 'developmental dyslexia', which is a global difficulty in reading beginning in childhood that may progress to adulthood. The dyslexias identified above are specific defects that are generally acquired rather than developmental.
Assessment of Writing
Ask the patient to make up and write a sentence. Note whether it contains a subject and a verb.
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