1. REFERENCES :
1.Teasdale G, Assessmentof coma and impaired consciousness.A practicalscale. Lancet 1974,2:81-84. PMID 413654
2. FolsteinMF, (1975). ""Mini-mental state".A practical methodforgradingthe cognitive state of patientsforthe clinician". Journalof psychiatricresearch
12 (3): 189–98.
DR. L.SUJA
FINALYEAR MEDICINEPG
GLASGOW COMA SCALE
The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow's Institute of
Neurological Sciences at the city's Southern General Hospital . GCS is a neurological scale that aims to give a reliable, objective way of
recording the conscious state of a person for initial as well as subsequent assessment. GCS was initially used to assess level of consciousness
after head injury, and to all acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in intensive care.
Elements of the scale
Interpretation
Individual elements as well as the sum
of the score are important. Hence, the
score is expressed in the form "GCS 9
= E2 V4 M3 at 07:35".
Generally, brain injury is classified as:
 Severe, with GCS ≤ 8
 Moderate, GCS 9 - 12
 Minor, GCS ≥ 13.
Tracheal intubation and severe facial/eye swelling or damage make it impossible to test the verbal and eye responses. In these circumstances, the
score is given as 1 with a modifier attached e.g. 'E1c' where 'c' = closed, or 'V1t' where t = tube. A composite might be 'GCS 5tc'. This would
mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for 'abnormal flexion'.
MINI-MENTAL STATE EXAMINATION
The mini-mental state examination (MMSE) or Folstein test is a brief 30-point questionnaire test that is used to screen for cognitive
impairment. It is commonly used in medicine to screen for dementia. It is also used to estimate the severity of cognitive impairment at a given
point in time and to follow the course of cognitive changes in an individual over time, thus making it an effective way to document an
individual's response to treatment.
In the time span of about 10 minutes it samples various functions including arithmetic, memory and orientation. It was introduced by Folstein et
al. in 1975,
Interpretation
Any score greater than or equal to 25 points
(out of 30) is effectively normal (intact).
Normal cognition >/= 25
Mild cognitive dysfunction 21-24
Moderate cognitive dysfunction 10-20
Severe cognitive dysfunction ≤9
1 2 3 4 5 6
Eyes Does not
open eyes
Opens eyes in
response to
painful stimuli
Opens eyes
in response
to voice
Opens eyes
spontaneously
N/A N/A
Verbal
Makes no
sounds
Incomprehensible
sounds
Utters
inappropriate
words
Confused,
disoriented
Oriented,
converses
normally
N/A
Motor Makes no
movements
Extension to
painful stimuli
(decerebrate
response)
Abnormal
flexion to
painful
stimuli
(decorticate
response)
Flexion /
Withdrawal
to painful
stimuli
Localizes
painful
stimuli
Obeys
commands
SECTION SCORE TASK
ORIENTATION 5 What is the date : year , season , date , day , month
5 Where are we : country , county , town , hospital , floor
REGISTERATION 3 Name 3 objects – 1 second to say each , then ask the patient to
recall all 3 . Repeat until patient has learnt all 3 .count and
record trials .
5 Serial 7s .one point for each correct .stop after 5 correct
.alternatively spell ‘ WORLD ‘ backwards
3 Ask for 3 objects repeated above
LANGUAGE 2 Name a pencil and watch
1 Repeat the following ‘ no ifs, ands , or buts’
3 Follow a 3-stage command: ‘ take a piece of paper in your right
hand , fold it in half and put it on the floor
3 Read and obey the following : ‘ close your eyes’ , ‘write a
sentence’ , ‘copy a design’
TOTAL SCORE 30