Screening for cognitive impairment in older people attending accident and emergency using the 4-item Abbreviated Mental Test

2010 ◽  
Vol 17 (6) ◽  
pp. 340-342 ◽  
Author(s):  
Irene Schofield ◽  
David J. Stott ◽  
Debbie Tolson ◽  
Angus McFadyen ◽  
James Monaghan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Mental Test ◽  
Accident And Emergency ◽  
Abbreviated Mental Test

Cognitive screening assessment in Thai older adults: a prospective study of the reliability and validity of the Abbreviated Mental Test

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kamonthip Tanglakmankhong ◽  
Benjamin M Hampstead ◽  
Robert J Ploutz-Snyder ◽  
Kathleen Potempa
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Reliability And Validity ◽  
Cognitive Screening ◽  
Mental Test ◽  
Content Type ◽  
Village Health Volunteers ◽  
Screening Assessment ◽  
Abbreviated Mental Test ◽  
Village Health

PurposeThe purpose of this paper is to examine the reliability and validity of the Abbreviated Mental Test (AMT) and the agreement with the Mini-Mental State Examination (MMSE).Design/methodology/approachThis cross-sectional study included 446 older adults who were recruited by cluster sampling from 200,481 adults aged more than 60 years. For each participant, the AMT was administered by village health volunteers and, on a separate day, by a trained professional who also administered the MMSE. Descriptive statistics, Bland and Altman levels of agreement, and Receiver Operator Curves (ROCs) were used to analyze data.FindingsAdministration of the AMT by village health volunteers during the annual health screening found cognitive impairment in only 1.12% of the sample. When the AMT was given to these same individuals by trained professionals, the rate of cognitive impairment was almost 24 times greater. Two items in the Thai AMT may require modification due to markedly elevated failure rates. At the cut score of 8, the sensitivity and specificity of the AMT relative to the MMSE were moderate (78.83 and 66.67%, respectively). The degree of agreement between AMT and MMSE was 0.49 (p < 0.001) and the correlation between the difference scores and the mean is exceptionally low (0.048).Originality/valueReliable and valid cognitive screening assessment requires the administrator to be well trained and the tools to be appropriate for the population. Although AMT is short and easy for a nonprofessional to administer, some items were not suitable due to construct validity and contextual issues.

scholarly journals Assessing the performance of the four question abbreviated mental test in the acute geriatric setting

2013 ◽  
Vol 12 (1) ◽  
pp. 13-17
Author(s):  
Thomas Locke ◽  
◽  
Sally Keat ◽  
Matthew Tate ◽  
Alexander Bown ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Hospital Admissions ◽  
Short Term Memory ◽  
Assessment Tool ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Acute Setting ◽  
Mental Test ◽  
Geriatric Hospital ◽  
Abbreviated Mental Test

Background: Cognitive impairment is common amongst acute geriatric hospital admissions but detection is often poor and this is associated with worse outcomes. The four-question abbreviated mental test (AMT4) has previously been promoted nationally in the acute setting as a succinct assessment tool. However, a recent national dementia Commissioning for Quality and Innovation (CQUIN) goal recommends a single screening question followed by the tenquestion abbreviated mental test (AMT10). We aimed to evaluate the negative predictive value of the AMT4 within the acute setting by comparing it to three other validated tools. Methods: We identified 100 acute medical admissions (>60 years old) with a negative AMT4 and administered the AMT10, six-item cognitive impairment test (6CIT) and confusion assessment method (CAM) within 24 hours of admission. Results: Forty-six percent of the participants scored positively on at least one of the additional tests despite a negative AMT4. Forty-four patients had a positive 6CIT, 23 had a positive AMT10 and six had a positive CAM. Using the 6CIT as a diagnostic standard, tests of short-term memory had the greatest sensitivity and specificity for cognitive impairment. Conclusions: Nearly half of the participants had signs of cognitive impairment despite a negative AMT4. Consequently, there is a risk of under diagnosis with potentially serious consequences for morbidity and mortality. Tests of shortterm memory were strongly associated with cognitive impairment. We propose the addition of such a test in order to increase the sensitivity of the AMT4 without compromising its brevity and utility in the acute setting.

scholarly journals The comparison of the 1972 Hodkinson’s Abbreviated Mental Test Score (AMTS) and its variants in screening for cognitive impairment

2018 ◽  
Vol 31 (4) ◽  
pp. 561-566 ◽  
Author(s):  
Karolina Piotrowicz ◽  
Wojciech Romanik ◽  
Anna Skalska ◽  
Barbara Gryglewska ◽  
Katarzyna Szczerbińska ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Test Score ◽  
Mental Test ◽  
Mental Test Score ◽  
Abbreviated Mental Test

scholarly journals Underestimation of Cognitive Impairment in Older Inpatients by the Abbreviated Mental Test Score versus the Montreal Cognitive Assessment: Cross-Sectional Observational Study

2020 ◽  
pp. 205-215
Author(s):  
Alexander Emery ◽  
James Wells ◽  
Stephen P. Klaus ◽  
Melissa Mather ◽  
Ana Pessoa ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Test Score ◽  
Testing Time ◽  
Mental Test ◽  
Mental Test Score ◽  
Severe Cognitive Impairment ◽  
Severe Impairment ◽  
Older Inpatients ◽  
Abbreviated Mental Test

<b><i>Background/Aims:</i></b> Cognitive impairment is prevalent in older inpatients but may be unrecognized. Screening to identify cognitive deficits is therefore important to optimize care. The 10-point Abbreviated Mental Test Score (AMTS) is widely used in acute hospital settings but its reliability for mild versus more severe cognitive impairment is unknown. We therefore studied the AMTS versus the 30-point Montreal Cognitive Assessment (MoCA) in older (≥75 years) inpatients. <b><i>Methods:</i></b> The AMTS and MoCA were administered to consecutive hospitalized patients at ≥72 h after admission in a prospective observational study. MoCA testing time was recorded. Reliability of the AMTS for the reference standard defined as mild (MoCA &#x3c;26) or moderate/severe (MoCA &#x3c;18) cognitive impairment was assessed using the area under the receiver-operating curve (AUC). Sensitivity, specificity, positive and negative predictive values of low AMTS (&#x3c;8) for cognitive impairment were determined. <b><i>Results:</i></b> Among 205 patients (mean/SD age = 84.9/6.3 years, 96 (46.8%) male, 74 (36.1%) dementia/delirium), mean/SD AMTS was 7.2/2.3, and mean/SD MoCA was 16.1/6.2 with mean/SD testing time = 17.9/7.2 min. 96/205 (46.8%) had low AMTS whereas 174/185 (94%) had low MoCA: 74/185 (40.0%) had mild and 100 ( 54.0%) had moderate/severe impairment. Moderate/severe cognitive impairment was more prevalent in the low versus the normal AMTS group: 74/83 (90%) versus 25/102 (25%, <i>p</i> &#x3c; 0.0001). AUC of the AMTS for mild and moderate/severe impairment were 0.86 (95% CI = 0.80–0.93) and 0.88 (0.82–0.93), respectively. Specificity of AMTS &#x3c;8 for both mild and moderate/severe cognitive impairment was high (100%, 71.5–100, and 92.7%, 84.8–97.3) but sensitivity was lower (44.8%, 37.0–52.8, and 72.8%, 62.6–81.6, respectively). The negative predictive value of AMTS &#x3c;8 was therefore low for mild impairment (10.9%, 5.6–18.7) but much higher for moderate/severe impairment (75.2%, 65.7–83.3). All MoCA subtests discriminated between low and normal AMTS groups (all <i>p</i> &#x3c; 0.0001, except <i>p</i> = 0.002 for repetition) but deficits in delayed recall, verbal fluency and visuo-executive function were prevalent even in the normal AMTS group. <b><i>Conclusion:</i></b> The AMTS is highly specific but relatively insensitive for cognitive impairment: a quarter of those with normal AMTS had moderate/severe impairment on the MoCA with widespread deficits. The AMTS cannot therefore be used as a “rule-out” test, and more detailed cognitive assessment will be required in selected patients.

Prioritization and management of calls from older people to GP out-of-hours services

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Suzanne Smith ◽  
Lucia Carragher
Keyword(s):  
Older People ◽  
Service Provision ◽  
Emergency Services ◽  
Oldest Old ◽  
Community Dwelling ◽  
Third Party ◽  
Older Person ◽  
Out Of Hours ◽  
Accident And Emergency ◽  
Community Dwelling Older People

Abstract Background Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.

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