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

Irene Schofield, David J Stott, Debbie Tolson, Angus McFadyen, James Monaghan, Derek Nelson

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To determine the utility of the 4-item Abbreviated Mental Test (AMT4) for detecting cognitive impairment in accident and emergency patients aged 65 years or older. Cognitive function was assessed using the Mini Mental State Examination (MMSE), 4 and 10-point AMT and subjective judgment. Cognitive impairment was defined as an MMSE score 23/30 or less. Of 601 patients, 226 (37.6%) scored 23 or less on MMSE. Cutoffs of 3 or less for AMT4 and 7 or less for AMT had sensitivities of 80% [95% confidence interval (CI): 0.75-0.85] and 76% (95% CI: 0.69-0.81), and specificities of 88% (95% CI: 0.84-0.91) and 93% (95% CI: 0.90-0.96), respectively, for detection of cognitive impairment; subjective judgement of admitting nurse had 50.5% (95% CI: 44-57%) sensitivity and 98.6% (95% CI: 0 96-1.00%) specificity. In conclusion, the AMT4 performs as well as the 10-point AMT in screening for cognitive impairment, and will assist in the early detection of cognitive problems.

Original languageEnglish
Pages (from-to)340-2
Number of pages3
JournalEuropean journal of emergency medicine : official journal of the European Society for Emergency Medicine
Issue number6
Publication statusPublished - Dec 2010



  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cognition
  • Cognition Disorders
  • Confidence Intervals
  • Female
  • Glasgow Coma Scale
  • Great Britain
  • Humans
  • Intelligence Tests
  • Male
  • Mass Screening
  • Psychological Tests
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Statistics as Topic

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