Editing Abbreviated mental test score

{{Infobox diagnostic
| name = Abbreviated Mental Test Score
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| purpose = Dementia diagnosis
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| calculator = 
| inventor = Hodkinson
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The '''Abbreviated Mental Test Score''' ('''AMTS''') is a 10-point test designed for the rapid assessment of [[elderly]] [[patient]]s for potential [[dementia]]. It is recommended as the primary screening tool in emergency and hospital settings for patients over 65.<ref name=":0">{{Cite journal |last1=Tafiadis |first1=Dionysios |first2=Ziavra ,Nafsika |first3=Prentza ,Alexandra |first4=Siafaka ,Vassiliki |first5=Zarokanellou ,Vasiliki |first6=Voniati, Louiza |last7=and Konitsiotis |first7=Spyridon |date=2022-09-03 |title=Validation of the Greek version of the Abbreviated Mental Test Score: Preliminary findings for cognitively impaired patients of different etiology |url=https://www.tandfonline.com/doi/full/10.1080/23279095.2020.1835915 |journal=Applied Neuropsychology: Adult |volume=29 |issue=5 |pages=1003–1014 |doi=10.1080/23279095.2020.1835915 |issn=2327-9095 |pmid=33119404|url-access=subscription }}</ref> First introduced in 1972,<ref name="Peters2021">{{cite journal |last1=Peters |first1=KA |last2=Howe |first2=TJ |last3=Rossiter |first3=D |last4=Hutchinson |first4=KJ |last5=Rosell |first5=PA |title=The Abbreviated Mental Test Score; Is There a Need for a Contemporaneous Update? |journal=Geriatric Orthopaedic Surgery & Rehabilitation |date=2021 |volume=12 |pages=21514593211001047 |doi=10.1177/21514593211001047 |pmid=34868721|pmc=8634377 }}</ref><ref name="hodkinson72">{{cite journal|last1=Hodkinson|first1=HM|title=Evaluation of a mental test score for assessment of mental impairment in the elderly.|journal=Age and Ageing|date=November 1972|volume=1|issue=4|pages=233–8|pmid=4669880|doi=10.1093/ageing/1.4.233}}</ref> it is now also utilized to assess [[mental confusion]] (including [[delirium]]) and other [[cognitive impairment]]s. The test takes approximately 3{{En dash}}4 minutes to administer and requires no specialist training or licensing.<ref name=":0" /><ref name=":1">{{Cite journal |last1=Jackson |first1=T. A. |last2=Naqvi |first2=S. H. |last3=Sheehan |first3=B. |date=2013-11-01 |title=Screening for dementia in general hospital inpatients: a systematic review and meta-analysis of available instruments |url=https://academic.oup.com/ageing/article-lookup/doi/10.1093/ageing/aft145 |journal=Age and Ageing |language=en |volume=42 |issue=6 |pages=689–695 |doi=10.1093/ageing/aft145 |pmid=24100618 |issn=0002-0729}}</ref><ref name=":2">{{Cite journal |last1=Foroughan |first1=Mahshid |last2=Wahlund |first2=Lars-Olof |last3=Jafari |first3=Zahra |last4=Rahgozar |first4=Mehdi |last5=Farahani |first5=Ida G. |last6=Rashedi |first6=Vahid |date=November 2017 |title=Validity and reliability of A bbreviated M ental T est S core ( AMTS ) among older I ranian |url=https://onlinelibrary.wiley.com/doi/10.1111/psyg.12276 |journal=Psychogeriatrics |language=en |volume=17 |issue=6 |pages=460–465 |doi=10.1111/psyg.12276 |pmid=28589659 |issn=1346-3500|url-access=subscription }}</ref>

==History==
The AMTS was developed to address the need for a rapid, practical method of assessing cognitive impairment in geriatric patients. In 1972, Hodkinson  adapted it from the 26-item Blessed Dementia Scale (BDS) by removing 16 items: 13 for repetitiveness, 2 for being too easy, and 1 for being too difficult.<ref name="hodkinson72" /> Validation studies revealed a near-linear correlation between AMTS and BDS scores, indicating strong [[convergent validity]] and measurement accuracy.<ref name="hodkinson72" />

=== Questionnaire and scoring ===
The standard AMTS consists of 10 questions that assess orientation, memory, and attention.<ref name="hodkinson72" /> 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,<ref name="HK">{{Cite journal|last1=Lam|first1=Simon C.|last2=Wong|first2=Yuet-ying|last3=Woo|first3=Jean|date=2010-11-01|title=Reliability and Validity of the Abbreviated Mental Test (Hong Kong Version) in Residential Care Homes|journal=Journal of the American Geriatrics Society|language=en|volume=58|issue=11|pages=2255–2257|doi=10.1111/j.1532-5415.2010.03129.x|pmid=21054326|s2cid=44719720 |issn=1532-5415}}</ref><ref name=":3">{{Cite journal |last1=Jitapunkul |first1=Sutthichai |last2=Pillay |first2=Isweri |last3=Ebrahim |first3=Shah |date=1991 |title=The Abbreviated Mental Test: Its Use and Validity |url=https://academic.oup.com/ageing/article-lookup/doi/10.1093/ageing/20.5.332 |journal=Age and Ageing |language=en |volume=20 |issue=5 |pages=332–336 |doi=10.1093/ageing/20.5.332 |pmid=1755388 |issn=0002-0729|url-access=subscription }}</ref> 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.<ref name="HK" />

{| class="wikitable" width="80%" border="1" align="center"
! width="80%" align="left" | Question<ref name="hodkinson72" /> 
|-
| What is your age? 
|-
| What is the time to the nearest hour? 
|-
| Give the patient an address, and ask him or her to repeat it at the end of the test.
|-
| What is the year? 
|-
| What is the name of this place (e.g. hospital)? 
|-
| Can the patient recognize two persons (the doctor, nurse, home help, etc.)? 
|-
| What is your date of birth? 
|- 9 / 2016
| In what year did [[World War I]] start?
|- trump
| Name the current [[Monarch]].
|-
| Count backwards from 20 down to 1. 
|}

=== Criticism and Calls for Updates ===
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;<ref name="Peters2021" /> however, even World War II is now beyond the lived experience of many older adults, causing the question to no longer assess time-orientation but rather [[semantic memory]]<ref name="Peters2021" /> as many patients struggle to answer correctly, not due to cognitive impairment but because of limited personal relevance, reducing the test's diagnostic accuracy.<ref name="Peters2021" /> Experts have suggested that recalling distant historical dates is an unreliable measure of cognitive impairment as answers are often confounded by [[Interference theory|retroactive interference]] from recent memories.<ref name=":4">{{Cite journal |last1=Piotrowicz |first1=Karolina |last2=Romanik |first2=Wojciech |last3=Skalska |first3=Anna |last4=Gryglewska |first4=Barbara |last5=Szczerbińska |first5=Katarzyna |last6=Derejczyk |first6=Jarosław |last7=Krzyżewski |first7=Roger M. |last8=Grodzicki |first8=Tomasz |last9=Gąsowski |first9=Jerzy |date=April 2019 |title=The comparison of the 1972 Hodkinson's Abbreviated Mental Test Score (AMTS) and its variants in screening for cognitive impairment |journal=Aging Clinical and Experimental Research |language=en |volume=31 |issue=4 |pages=561–566 |doi=10.1007/s40520-018-1009-7 |issn=1720-8319 |pmc=6439164 |pmid=30062669}}</ref>

As no formal administration training is required, many clinicians administer and score the AMTS incorrectly.<ref>{{Cite journal |last1=Holmes |first1=J. |last2=Gilbody |first2=S. |date=1996-08-24 |title=Differences in use of abbreviated mental test score by geriatricians and psychiatrists |journal=BMJ |language=en |volume=313 |issue=7055 |pages=465 |doi=10.1136/bmj.313.7055.465 |issn=0959-8138 |pmc=2351872 |pmid=8776314}}</ref> Score cut-off thresholds for cognitive impairment vary widely from 6–10, undermining the test's diagnostic [[Reliability (statistics)|reliability]].<ref name=":3" />

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.<ref name=":3" /><ref name=":5">{{Cite journal |last1=Emery |first1=Alexander |last2=Wells |first2=James |last3=Klaus |first3=Stephen P. |last4=Mather |first4=Melissa |last5=Pessoa |first5=Ana |last6=Pendlebury |first6=Sarah T. |date=2020-12-15 |title=Underestimation of Cognitive Impairment in Older Inpatients by the Abbreviated Mental Test Score versus the Montreal Cognitive Assessment: Cross-Sectional Observational Study |journal=Dementia and Geriatric Cognitive Disorders Extra |language=en |volume=10 |issue=3 |pages=205–215 |doi=10.1159/000509357 |issn=1664-5464 |pmc=7841750 |pmid=33569076}}</ref>

'''Shorter Versions'''

The AMT4 uses 4 items from the AMTS, with a cut off score of 3 or 4 compared to the usual 8 or 9.<ref name="pubmed.ncbi.nlm.nih.gov">{{Cite journal |last1=I |first1=Schofield |last2=Dj |first2=Stott |last3=D |first3=Tolson |last4=A |first4=McFadyen |last5=J |first5=Monaghan |last6=D |first6=Nelson |date=December 2010 |title=Screening for Cognitive Impairment in Older People Attending Accident and Emergency Using the 4-item Abbreviated Mental Test |url=https://pubmed.ncbi.nlm.nih.gov/20164778/ |journal=European Journal of Emergency Medicine |language=en |volume=17 |issue=6 |pages=340–342 |doi=10.1097/MEJ.0b013e32833777ab |pmid=20164778 |s2cid=12321807 |access-date=2020-05-27}}</ref> The AMT4 is part of the [[4AT]] scale for [[delirium]]. The AMT5<ref name=":3" /> includes 5 items. Despite its cut-off score of 4, it is still highly prone to [[False positives and false negatives|false-positives]].

The AMT7<ref name=":3" /> includes 7 items. At a cut-off score of 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 ==
The original AMTS has limited cultural validity<ref>{{Citation |last1=Huang |first1=Wendy Y. |title=Cross-Cultural Validation |date=2014 |encyclopedia=Encyclopedia of Quality of Life and Well-Being Research |pages=1369–1371 |editor-last=Michalos |editor-first=Alex C. |url=https://link.springer.com/referenceworkentry/10.1007/978-94-007-0753-5_630 |access-date=2025-05-25 |place=Dordrecht |publisher=Springer Netherlands |language=en |doi=10.1007/978-94-007-0753-5_630 |isbn=978-94-007-0753-5 |last2=Wong |first2=Stephen H.}}</ref> as it relies on UK-specific knowledge, such as naming the current Monarch.<ref name="hodkinson72" /> This limits its generalisability to non-UK settings, requiring countries to adapt questions to avoid misdiagnosis. It also has limited [[construct validity]] as some items no longer test time-orientation but factual [[Fluid and crystallized intelligence|crystal intelligence]], requiring questions to be adapted to more recent events.<ref name=":4" />

Despite these limitations, the AMTS demonstrates strong [[convergent validity]] between different diagnostic tools and versions.<ref name=":2" /><ref name=":4" /> High [[Repeatability|test-retest]] reliability makes the AMTS more applicable by producing consistent results over time,<ref name="HK" /> allowing clinicians to reliably track changes in cognitive function.

'''Comparison to Other Tools'''

The AMTS has been shown to outperform tests like the [[Memory span|Digit Span Backwards Test]], Time and Change Test,<ref>{{Cite journal |last1=Rhee |first1=Jung-Ae |last2=Chung |first2=Eun-Kyung |last3=Shin |first3=Min-Ho |date=2004-11-04 |title=Validating the Time and Change test to screen for dementia in elderly Koreans |journal=BMC Public Health |volume=4 |issue=1 |pages=52 |doi=10.1186/1471-2458-4-52 |doi-access=free |pmid=15527503 |pmc=533880 |issn=1471-2458}}</ref> [[IQCODE]], SPMSQ,<ref>{{Cite web |date=2014-02-18 |title=The Short Portable Mental Status Questionnaire (SPMSQ) |url=https://geriatrics.stanford.edu/culturemed/overview/assessment/assessment_toolkit/spmsq.html |access-date=2025-05-25 |website=Geriatrics |language=en-US}}</ref> and the frequently used [[Mini–mental state examination|MMSE]] in general hospital settings by exhibiting high diagnostic accuracy, ease of use, and brevity.<ref name=":1" /> The AMTS show strong convergent validity with MMSE scores while taking 3–4 minutes to administer rather than 10–15.<ref name=":2" /> 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.<ref name=":6">{{Cite journal |last1=Kamalzadeh |first1=Leila |last2=Tayyebi |first2=Gooya |last3=Shariati |first3=Behnam |last4=Shati |first4=Mohsen |last5=Saeedi |first5=Vahid |last6=Malakouti |first6=Seyed Kazem |date=2024-05-14 |title=Diagnostic accuracy of cognitive screening tools validated for older adults in Iran: a systematic review and meta-analysis |journal=BMC Geriatrics |language=en |volume=24 |issue=1 |page=428 |doi=10.1186/s12877-024-04963-w |doi-access=free |issn=1471-2318 |pmc=11095008 |pmid=38745116}}</ref>

Hwever, the AMTS is less effective at detecting [[mild cognitive impairment]], missing over half of cases compared to the [[Montreal Cognitive Assessment|MoCA]] which provides a more comprehensive cognitive profile.<ref name=":5" /> The AMTS's narrow focus on memory and orientation leads to a ceiling effect, reducing its usefulness for early cognitive impairment detection.<ref name=":0" /><ref name=":6" />

'''International Adaptations'''

The AMTS demonstrates strong reliability and validity across different cultures,<ref>{{Cite web |date=2014-02-18 |title=The Short Portable Mental Status Questionnaire (SPMSQ) |url=https://geriatrics.stanford.edu/culturemed/overview/assessment/assessment_toolkit/spmsq.html |access-date=2025-05-25 |website=Geriatrics |language=en-US}}</ref> with most versions using similar cut-off scores to identify cognitive impairment.<ref name=":0" />

=== Hong Kong<ref name="HK" /> ===
The AMTS was adapted in Hong Kong 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 an effective cognitive screening tool.

=== Iran<ref name=":2" /> ===
In Iran, the AMTS's World War I question was replaced with the [[Iran–Iraq War|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 requirements, making it suitable for over-crowded and under-funded hospital settings. Additionally, unlike other cognitive tests, results are not affected by education or literacy levels, critical in Iran where many elderly adults lack formal education.

=== Poland<ref name=":4" /> ===
The AMTS was adapted in Poland 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.

=== Thailand<ref>{{Cite journal |last1=Tanglakmankhong |first1=Kamonthip |last2=Hampstead |first2=Benjamin M. |last3=Ploutz-Snyder |first3=Robert J. |last4=Potempa |first4=Kathleen |date=2021 |title=Does the Abbreviated Mental Test Accurately Predict Cognitive Impairment in Thai Older Adults? A Retrospective Study |journal=Pacific Rim International Journal of Nursing Research |volume=25 |issue=1 |pages=23–33 |issn=1906-8107 |pmc=9565848 |pmid=36246051}}</ref> ===
In Thailand, the AMTS was adapted by replacing the World War I question with the date of the [[1973 Thai popular uprising|Great Sorrow]], the Monarch’s name with the Thai King, and the address recall task with the patient’s current address. The last change aimed to reflect cultural norms, as most rural elderly individuals are unfamiliar with 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 shows high rates of [[False positives and false negatives|false-negative]] diagnoses. Many older adults were unable to provide their birth date or recall the current year due to [[Thai calendar|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==
*[[General Practitioner Assessment Of Cognition]]
*[[GERRI]]
*[[Mini-mental state examination]]

==References==
{{reflist}}

{{Neuropsychology tests}}

[[Category:Cognitive impairment and dementia screening and assessment tools]]
[[Category:Geriatrics]]