Mental Status Questionnaire (MSQ)

Abstract

The Mental Status Questionnaire (MSQ), developed by Kahn and colleagues in 1960, is a brief, objective screening instrument designed for the rapid assessment of cognitive impairment, particularly among the elderly. Comprising ten simple questions primarily focused on orientation and general information, the MSQ yields a simple error score used to quickly categorize the severity of mental status deterioration.

It was historically significant as one of the earliest standardized brief tests for assessing mental function in geriatrics settings. The MSQ is often utilized as a precursor to more comprehensive neurocognitive examinations, providing a fundamental measure of the patient’s awareness of time, place, and person.

Keywords

Mental Status Questionnaire, MSQ, Kahn, 1960, Cognitive Assessment, Orientation, Geriatric Psychiatry, Screening Tool, Dementia, Aged.

Authors

Robert L. Kahn, Alvin I. Goldfarb, Max Pollack, Arthur Peck.

Purpose

The primary purpose of the MSQ is to provide a quick, quantifiable measure of mental status, specifically designed for use with aged individuals. It functions as a rapid screening tool to differentiate between individuals who are cognitively intact and those who exhibit signs of mild to severe cognitive impairment, often associated with organic brain syndrome or early dementia.

The scale is structured to be easily administered by various healthcare professionals, including nurses and clinicians, requiring minimal training and time (typically less than five minutes). Its utility lies in its efficiency in large clinical or institutional settings, such as nursing homes, where repeated, quick checks of mental function are necessary to monitor status changes.

Construct

The MSQ fundamentally measures the construct of Orientation to Time, Place, and Person, alongside general recall of personal and public information. This construct is viewed as a foundational aspect of cognition that is typically compromised early in the progression of neurodegenerative diseases.

The ten items are scored objectively based on whether the answer is correct or incorrect, resulting in a total error score ranging from 0 to 10. Higher scores indicate greater cognitive deficit. The scale serves as a proxy measure for global mental deterioration, though its brevity limits its ability to provide detailed information on specific cognitive domains like executive function or language.

Validity

Studies examining the validity of the MSQ, including work by Fillenbaum (1980), generally support its use as a measure of organic brain impairment in the elderly. The MSQ has demonstrated good concurrent validity when compared to longer, more detailed mental status assessments, showing significant correlations with related measures such as the Short Portable Mental Status Questionnaire (SPMSQ).

The scale’s face validity is high, as the items directly query standard knowledge and current environmental awareness. Its utility in differentiating between various levels of dementia severity confirms its criterion validity, although its brevity means it may lack the sensitivity required to detect subtle or very early-stage cognitive impairments compared to instruments like the Mini-Mental State Examination (MMSE).

Reliability

The MSQ exhibits strong inter-rater reliability due to its highly objective, dichotomous scoring method (correct/incorrect). There is minimal need for clinician interpretation regarding the correctness of the answers (Lesher & Whelihan, 1986). This standardized scoring procedure makes the instrument highly reproducible across different administrators and settings.

While test-retest reliability is generally considered acceptable for stable populations, the scale is sensitive to acute changes in mental status (e.g., those caused by delirium or medication changes). The internal consistency (often measured via Cronbach’s alpha) is typically moderate, reflecting that while all items measure general disorientation, they cover slightly different domains of time, place, and personal information.

Factor Analysis

The MSQ is a brief, unidimensional scale often treated as a single index of cognitive function related to orientation. Formal factor analysis is rarely applied to the MSQ due to its limited number of items (n=10) and its primary role as a rapid screening tool rather than a comprehensive diagnostic instrument. Researchers typically utilize the total error score as the singular outcome measure, implying a unitary underlying factor of global mental status deterioration or disorientation.

Instrument

Test Type: Brief Screening Tool for Cognitive Impairment.

Format: Structured Interview/Verbal Questionnaire administered face-to-face.

Language Available: Primarily English (Original). Adaptations exist in various languages but require specific validation.

Population Group: Clinical and Institutional Settings (Hospitals, Nursing Homes, Outpatient Clinics).

Age Group: Elderly or Aged Population (Geriatric focus).

Population Details: Individuals suspected of or diagnosed with mild to severe mental status changes or organic brain syndrome. Appropriate for use in populations with low educational attainment.

Test Methodology: Administration of 10 fixed questions. Scoring is based on the number of incorrect responses (0-10 errors). Cut-off scores are applied to categorize severity (e.g., 0-2 errors = intact; 3-8 errors = mild/moderate impairment; 9-10 errors = severe impairment).

Keywords

Mental status, orientation, aging, dementia screening, objective measure, Kahn scale, organic brain syndrome, geriatric assessment.

Authors

Author ORCID Identifier: Not publicly available for R.L. Kahn (1960).

Affiliation Email addresses: Information not available.

Correspondence Address: Information not available.

Permissions & Fee and Test Year

The Mental Status Questionnaire (MSQ) was published in 1960. As a brief, widely used, and early psychological screening tool, the items are generally considered to be in the public domain for clinical and research use, though users should always cite the original source (Kahn et al., 1960). No specific fee or formal permission structure is typically required for its administration.

The original PDF describing the instrument and context can be downloaded here: www.a4ebm.org/sites/default/files/Measuring Health.pdf

Reference’s

Kahn, R.L., Goldfarb, A.I., Pollack, M., & Peck, A. (1960). Brief objective measures for the determination of mental status in the aged. Am J Psychiatry, 117:326–328.

Fillenbaum, G.G. (1980). Comparison of two brief tests of organic brain impairment. Journal of the American Geriatrics Society, 28(8): 381-384.

Lesher, E.L., & Whelihan, W.M. (1986). Reliability of mental status instruments administered to nursing home residents. J Consult Clin Psychol, 54:726–727.

McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition. OXFORD UNIVERSITY PRESS.

Items of the Mental Status Questionnaire (MSQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. What is the name of this place?
2. Where is it located (address)?
3. What is today’s date?
4. What is the month now?
5. What is the year?
6. How old are you?
7. When were you born (month)?
8. When were you born (year)?
9. Who is the president of the United States?
10. Who was the president before him?