Abbreviated Mental Test Score (AMTS & AMT-4)

Assesses mental impairment in geriatric patients.

Refer to the text below the form for more information about the two score options and their interpretation.

AMTS and its shorter version, the AMT-4, are 10, respective 4-point assessments that can be used to rapidly evaluate elderly patients for delirium and dementia. Further tests are then necessary to confirm a diagnosis.

Both versions of the score are easy to use and interpret, but the AMT-4 was shown to be more easy to adopt, in contrast to the AMTS which despite its availability has been shown to be infrequently and incorrectly used in practice.

AMT-4 had shown statistically close correlation with the full AMTS score.

Ask the patient about:
1Their age
2Time (To the nearest hour)
Instruction: Give the patient the following address for recall at the end of test: “42 West Street” (have patient repeat to ensure it has been heard correctly).
3Current year
4Patient’s home address
5What jobs do these people do? Show the patient two pictures: a postman and a cook
6Date of birth
7Year World War I started
8Current president Use setting-specific equivalent, e.g. “monarch” in the UK
9Count backwards from 20 to 1
10Ask to recall address given earlier (42 West Street)
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Ask the patient about:
1Age
2Date of birth
3Current place
4Year
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AMTS explained

The Abbreviated Mental Test Score is a 10-point assessment introduced by Hodkinson in 1972 to facilitate a quick evaluation of elderly patients suspected of suffering from dementia. Along with its newer (published in 1997) and shorter version AMT-4, it continues to be part of the screening processes for delirium and dementia in many clinical settings.

The table below summarises the two versions of the score, along with their interpretations:

AMTS (AMT-10) AMT-4
Add 1 point for each correct answer Add 1 point for each correct answer
Ask the patient about:
1. Their age
2. The time (to the nearest hour)
* pause to give the patient the following address for recall at the end of test: “42 West Street” (have patient repeat to ensure it has been heard correctly)
3.Current year
4. Patient’s home address
5. What jobs do these people do? Show the patient two pictures: a postman and a cook
6. Date of birth
7. Year World War I started
8. Current president (Use setting-specific equivalent, e.g. “monarch” in the UK)
9. To count backwards from 20 to 1
10. Ask to recall address given earlier (42 West St.)		 Ask the patient about:
1. Age
2. Date of birth
3. Current place
4. Year
AMTS score interpretation:
7 – 10: No delirium
4 – 6: Moderate cognitive impairment
0 – 3: Severe cognitive impairment		 AMT-4 score interpretation:
4: Normal cognition
0 – 3: Abnormal cognition

AMTS is also used to assess for mental confusion, including delirium, and other cognitive impairments, as well as for monitoring improvement or deterioration of cognitive function in admitted patients.

A cut off score of 3 on the AMT-4 performs comparably to the AMTS cut-off of 8.

The AMT-4 is part of the 4AT scale for delirium.

The tools on their own cannot diagnose delirium or dementia so further examination is required.

AMTS is limited in patients with reduced GCS or where there is a language barrier so the test cannot be completed.

There are discussions that the First World War and current president/monarch question is sometimes found tricky by younger patients to answer (but not linked to cognitive impairment as assessed by the AMTS) so potentially impacting the accuracy of the cognitive function evaluation.

 

About the original studies and validation

AMTS score (also known as AMT-10) was first published and validated in 1972, then later in 1974 for institutionalised patients. It is widely used in research and clinical practice. In further validation studies it was found to be a reliable tool in screening for cognitive impairment.

In 1992 a shorter version, the AMT-4 was developed. The AMT4 scores were then determined and matched against AMT scores. The performance of all 210 possible four-item combinations derivable from the AMT was assessed and ranked according to predictive efficiency (the percentage of patients whose cognition as judged by the AMT was correctly categorized by each four-item combination).

The AMT-4 showed a statistically significant correlation with AMT score (Somers' d statistic 0.90: p < 0.001). The AMT4 had a predictive efficiency of 91% and ranked 7 = /210 possible four-item combinations.

In a further validation study, the AMT-4 was compared with the AMTS, 6CIT and confusion assessment method (CAM) by administering to 100 acute medical admissions (>60 years old), within 24h of admission.

46% of the participants scored positively on at least one of the additional test despite a negative AMT-4, raising concerns that there is a risk of under-diagnosis with potential serious morbidity and mortality consequences.

It was also found that the 6CIT, as short-term memory assessment showed the greatest sensitivity and specificity for cognitive impairments.

The study advised the use of short-term memory tests, such as the 6CIT, to accompany the AMT-4 to increase its sensitivity without compromising its brevity and utility, especially in acute settings.

 

References

Original references

Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing. 1972; 1(4):233-8.

Swain DG, Nightingale PG. Evaluation of a shortened version of the Abbreviated Mental Test in a series of elderly patients. Clin Rehabil. 1997; 11(3):243-8.

Validation

Piotrowicz K, Romanik W, Skalska A, Gryglewska B, Szczerbińska K, Derejczyk J, Krzyżewski RM, Grodzicki T, Gąsowski J. The comparison of the 1972 Hodkinson's Abbreviated Mental Test Score (AMTS) and its variants in screening for cognitive impairment. Aging Clin Exp Res. 2019; 31(4):561-566.

Locke T, Keat S, Tate M, Bown A, Hart A, Ghosh R. Assessing the performance of the four question abbreviated mental test in the acute geriatric setting. Acute Med. 2013; 12(1):13-7.

Specialty: Geriatrics

System: Nervous

Objective: Evaluation

Type: Score

Year Of Study: 1972, 1997

Abbreviation: AMTS, AMT-4

Article By: Denise Nedea

Published On: September 17, 2024

Last Checked: September 17, 2024

Next Review: September 17, 2029