Abbreviated mental test score
| Abbreviated mental test score | |
|---|---|
| Purpose | determine dementia in the elderly |
The Abbreviated Mental Test Score (AMTS) is a 10-point test for rapidly assessing elderly patients for the possibility of dementia. It is recommended as the go-to screening tool in emergency and hospital settings for patients over 65.[1] It was first used in 1972,[2][3] and is now sometimes also used to assess for mental confusion (including delirium) and other cognitive impairments. It takes approximately 3–4 minutes to administer and requires no specialist training or licensing.[1][4][5]
History
[edit]The AMTS was developed to address the need for a rapid, practical method of assessing cognitive impairment in geriatric patients. It was adapted by Hodkinson (1972) from the 26-item Blessed Dementia Scale (BDS) by removing 16 items: 13 for repetitiveness, 2 for being too easy, 1 for being too difficult.[3] Validation studies revealed a near-linear correlation between AMTS and BDS scores, indicating strong convergent validity and accuracy of measurement.[3]
Questionnaire and Scoring
[edit]The standard AMTS consists of 10 questions that assess orientation, memory, and attention.[3] The following questions are put to the patient. Each question correctly answered scores one point. A score of 7–8 or less suggests cognitive impairment at the time of testing,[6][7] although further and more formal tests are necessary to confirm a diagnosis of dementia, delirium or other causes of cognitive impairment. Culturally-specific questions may vary based on region.[6]
| Question[3] | Score |
|---|---|
| What is your age? (1 point) | |
| What is the time to the nearest hour? (1 point) | |
| Give the patient an address, and ask him or her to repeat it at the end of the test. (1 point) | |
| What is the year? (1 point) | |
| What is the name of this place (e.g. hospital) (1 point) | |
| Can the patient recognize two persons (the doctor, nurse, home help, etc.)? (1 point) | |
| What is your date of birth? (1 point) | |
| In what year did World War I start? (1 point) | |
| Name the current Monarch. (1 point) | |
| Count backwards from 20 down to 1. (1 point) |
Criticism and Calls for Updates
[edit]The AMTS has been criticised for containing culturally and temporally outdated questions. For example, the World War I question was gradually revised to ask for the start of World War II as fewer elderly patients had direct experience of the earlier conflict post-1970s.[2] However, even World War II is now beyond the lived experience of many older adults. As a result, these questions no longer assess time-orientation but semantic memory.[2] Many patients struggle to answer correctly, not due to cognitive impairment but because of limited personal relevance, reducing the diagnostic accuracy of the test.[2] Experts have suggested that recalling distant historical dates is an unreliable measure of cognitive impairment as answers are often confounded by retroactive interference from recent memories.[8] It has been recommended that these items be replaced with questions referencing recent and culturally relevant events to improve the test’s validity.
As no formal administration training is required, many clinicians administer and score the AMTS incorrectly.[9] Score cut-off thresholds for cognitive impairment vary widely from 6–10, undermining the test's diagnostic reliability.[7]
The AMTS poorly distinguishes between dementia and delirium, and lacks sensitivity to detect mild cognitive impairment, making it a poor tool for differentiation and early-stage diagnostics.[7][10]
Shorter Versions
The AMT4 uses 4 items from the AMTS: (i) What is your age? (ii) What is your date of birth? (iii) What is the name of this place? (iv) What is the year? A cut off score of 3/4 performs comparably to an AMTS cut-off score of 8/9.[11] The AMT4 is part of the 4AT scale for delirium.
AMT5:[7] Includes 5 items - address recall, recognition of two people, date of birth, current monarch, and counting backwards from 20. Despite cut-off score being adjusted to 4, it is still highly prone to false-positives.
AMT7:[7] Includes 7 items - current time, address recall, recognition of two people, date of birth, current monarch, and counting backwards from 20. When the cut-off score was adjusted to 5, the same sensitivity and specificity levels were observed as in the original AMTS, making it the most reliable short-form version without compromising diagnostic accuracy.
Validity and Reliability
[edit]The original AMTS has limited cultural validity as it relies on UK-specific knowledge such as naming the current Monarch.[3] This limits its generalisability to non-UK settings requiring countries to adapt questions to avoid misdiagnosis. It also has limited construct validity as items like the start year of WWI no longer test time-orientation but factual crystal intelligence, requiring questions to be adapted to more recent events.[8]
Despite these limitations, the AMTS demonstrates strong convergent validity between different diagnostic tools and versions of the AMTS.[5][8] High test-retest reliability makes the AMTS more applicable by producing consistent results over time,[6] allowing clinicians to reliably track changes in cognitive function.
Comparison to Other Tools
The AMTS has been shown to outperform tests like the Digit Span Backwards Test, Time and Change Test, IQCODE, SPMSQ, and the frequently used MMSE in general hospital settings by exhibiting high diagnostic accuracy, ease of use, and brevity.[4] AMTS show strong convergent validity with MMSE scores while taking 3–4 minutes to administer rather than 10–15.[5] Unlike many other cognitive tests, the AMTS is not significantly influenced by the patient's education level, making it suitable for diagnosing dementia in individuals with limited literacy.[12]
The AMTS is less effective at detecting mild cognitive impairment, missing over half of cases compared to the MoCA which provides a more comprehensive cognitive profile.[10] AMTS's narrow focus on memory and orientation leads to a ceiling effect, reducing its usefulness for early cognitive impairment detection.[1][12]
International Adaptations
The AMTS demonstrates strong reliability and validity across different languages and cultures, with most versions using similar cut-off scores to identify cognitive impairment.[1]
The AMTS was adapted by replacing the World War I question with the Mid-Autumn Festival and the Monarch’s name with the current Chinese leader.
The adapted version had a cut-off score of 7, with high sensitivity (92%) and specificity (87%), indicating strong validity. It also demonstrated high internal consistency and test-retest reliability, making it a highly effective cognitive screening tool.
The AMTS was adapted by replacing the World War I question with the Iraqi-Iranian War and the Monarch’s name with the Iranian leader.
The Persian version was confirmed to have high statistical validity, specificity, and sensitivity. It proved more applicable than the MMSE in Iran due to its brevity and lack of licensing requirement, making it suitable for the over-crowded and under-funded hospital settings. Additionally, unlike other cognitive tests, results are not affected by education or literacy levels which is critical for testing in Iran where many elderly adults lack formal education.
The AMTS was adapted by replacing the World War I question with World War II and the Monarch’s name with the Polish President.
The Polish version showed a strong correlation with the original AMTS, with no significant differences in sensitivity or specificity, confirming its effectiveness as a culturally adapted screening tool.
The AMTS was adapted by replacing the World War I question with the date of the Great Sorrow, the Monarch’s name with the Thai King, and the address recall task with asking the patient’s current address. The last change aimed to reflect cultural norms, as most rural elderly individuals are unfamiliar with the task of memorising arbitrary information like made-up addresses. This alteration has been criticised for shifting the task from testing short-term memory to semantic memory.
Despite these adaptations, the Thai AMTS still shows high rates of false-negative diagnoses. Many older adults were unable to provide their birth date or recall the current year due to Thailand’s mixed lunar/solar calendar system. These issues highlight the cultural limitations of the AMTS and the need for further adaptation in Thailand.
See also
[edit]- General Practitioner Assessment Of Cognition – a brief screening tool for cognitive impairment designed for primary care
- GERRI
- Mini-mental state examination
References
[edit]- ^ a b c d Tafiadis, Dionysios; and Konitsiotis, Spyridon (2022-09-03). "Validation of the Greek version of the Abbreviated Mental Test Score: Preliminary findings for cognitively impaired patients of different etiology". Applied Neuropsychology: Adult. 29 (5): 1003–1014. doi:10.1080/23279095.2020.1835915. ISSN 2327-9095. PMID 33119404.
{{cite journal}}:|first2=missing|last2=(help);|first3=missing|last3=(help);|first4=missing|last4=(help);|first5=missing|last5=(help);|first6=missing|last6=(help)CS1 maint: multiple names: authors list (link) - ^ a b c d Peters, KA; Howe, TJ; Rossiter, D; Hutchinson, KJ; Rosell, PA (2021). "The Abbreviated Mental Test Score; Is There a Need for a Contemporaneous Update?". Geriatric Orthopaedic Surgery & Rehabilitation. 12: 21514593211001047. doi:10.1177/21514593211001047. PMC 8634377. PMID 34868721.
- ^ a b c d e f Hodkinson, HM (November 1972). "Evaluation of a mental test score for assessment of mental impairment in the elderly". Age and Ageing. 1 (4): 233–8. doi:10.1093/ageing/1.4.233. PMID 4669880.
- ^ a b Jackson, T. A.; Naqvi, S. H.; Sheehan, B. (2013-11-01). "Screening for dementia in general hospital inpatients: a systematic review and meta-analysis of available instruments". Age and Ageing. 42 (6): 689–695. doi:10.1093/ageing/aft145. ISSN 0002-0729.
- ^ a b c d Foroughan, Mahshid; Wahlund, Lars‐Olof; Jafari, Zahra; Rahgozar, Mehdi; Farahani, Ida G.; Rashedi, Vahid (2017-11). "Validity and reliability of A bbreviated M ental T est S core ( AMTS ) among older I ranian". Psychogeriatrics. 17 (6): 460–465. doi:10.1111/psyg.12276. ISSN 1346-3500.
{{cite journal}}: Check date values in:|date=(help) - ^ a b c d Lam, Simon C.; Wong, Yuet-ying; Woo, Jean (2010-11-01). "Reliability and Validity of the Abbreviated Mental Test (Hong Kong Version) in Residential Care Homes". Journal of the American Geriatrics Society. 58 (11): 2255–2257. doi:10.1111/j.1532-5415.2010.03129.x. ISSN 1532-5415. PMID 21054326. S2CID 44719720.
- ^ a b c d e Jitapunkul, Sutthichai; Pillay, Isweri; Ebrahim, Shah (1991). "The Abbreviated Mental Test: Its Use and Validity". Age and Ageing. 20 (5): 332–336. doi:10.1093/ageing/20.5.332. ISSN 0002-0729.
- ^ a b c d Piotrowicz, Karolina; Romanik, Wojciech; Skalska, Anna; Gryglewska, Barbara; Szczerbińska, Katarzyna; Derejczyk, Jarosław; Krzyżewski, Roger M.; Grodzicki, Tomasz; Gąsowski, Jerzy (2019-04). "The comparison of the 1972 Hodkinson's Abbreviated Mental Test Score (AMTS) and its variants in screening for cognitive impairment". Aging Clinical and Experimental Research. 31 (4): 561–566. doi:10.1007/s40520-018-1009-7. ISSN 1720-8319. PMC 6439164. PMID 30062669.
{{cite journal}}: Check date values in:|date=(help) - ^ Holmes, J.; Gilbody, S. (1996-08-24). "Differences in use of abbreviated mental test score by geriatricians and psychiatrists". BMJ. 313 (7055): 465–465. doi:10.1136/bmj.313.7055.465. ISSN 0959-8138. PMC 2351872. PMID 8776314.
- ^ a b Emery, Alexander; Wells, James; Klaus, Stephen P.; Mather, Melissa; Pessoa, Ana; Pendlebury, Sarah T. (2020-12-15). "Underestimation of Cognitive Impairment in Older Inpatients by the Abbreviated Mental Test Score versus the Montreal Cognitive Assessment: Cross-Sectional Observational Study". Dementia and Geriatric Cognitive Disorders Extra. 10 (3): 205–215. doi:10.1159/000509357. ISSN 1664-5464. PMC 7841750. PMID 33569076.
{{cite journal}}: no-break space character in|first3=at position 8 (help); no-break space character in|first6=at position 6 (help) - ^ I, Schofield; Dj, Stott; D, Tolson; A, McFadyen; J, Monaghan; D, Nelson (December 2010). "Screening for Cognitive Impairment in Older People Attending Accident and Emergency Using the 4-item Abbreviated Mental Test". European Journal of Emergency Medicine. 17 (6): 340–342. doi:10.1097/MEJ.0b013e32833777ab. PMID 20164778. S2CID 12321807. Retrieved 2020-05-27.
- ^ a b Kamalzadeh, Leila; Tayyebi, Gooya; Shariati, Behnam; Shati, Mohsen; Saeedi, Vahid; Malakouti, Seyed Kazem (2024-05-14). "Diagnostic accuracy of cognitive screening tools validated for older adults in Iran: a systematic review and meta-analysis". BMC Geriatrics. 24 (1). doi:10.1186/s12877-024-04963-w. ISSN 1471-2318. PMC 11095008. PMID 38745116.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Tanglakmankhong, Kamonthip; Hampstead, Benjamin M.; Ploutz-Snyder, Robert J.; Potempa, Kathleen (2021). "Does the Abbreviated Mental Test Accurately Predict Cognitive Impairment in Thai Older Adults? A Retrospective Study". Pacific Rim International Journal of Nursing Research. 25 (1): 23–33. ISSN 1906-8107. PMC 9565848. PMID 36246051.
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