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One hundred and fifty unselected elderly community subjects were assessed by Mini-Mental State Examination (MMSE), Abbreviated Mental Test (AMT) and Mental Status Questionnaire (MSQ). The effects on cognitive test scores of potential confounding (non-cognitive) variables were evaluated. Sensitivities and specificities were: MMSE 80% and 98%; AMT 77% and 90%; and MSQ 70% and 89%. The MMSE identified significantly fewer false positives than the AMT and MSQ. The major effect of intelligence on cognitive test scores has previously been underestimated. Age, social class, sensitivity of hearing and history of stroke were also significantly correlated with cognitive test scores. Years of full time education and depression only affected the longer MMSE and CAMCOG. The MMSE (cut-off 20/21) can be recommended for routine screening. However, as scores are affected by variables other than cognitive function, particularly intelligence, further assessment of identified cases may fail to reveal significant functional impairment.
Groups of organically and functionally mentally ill psychogeriatric day patients were assessed by the 37-item Roth-Hopkins test and the abbreviated ten-item Roth-Hopkins test. The scores correlated highly, correlation being equally good for both diagnostic groups. Among the functionally ill and the mild organically ill, scores improved between first and second test. The quicker, better tolerated ten-item test is a useful test of mental impairment for psychogeriatric patients in the community, as well as in institutional care.
OBJECTIVES: the abbreviated mental test is widely used in the assessment of cognitive impairment in elderly patients. However, many doctors do not administer the full 10 questions, preferring to estimate the patient's score instead. We have studied the accuracy of doctors in predicting patients' abbreviated mental test scores. METHODS: we assessed 102 patients in the geriatric unit. We asked doctors to predict the patient's abbreviated mental test during the admission interview. A true abbreviated mental test was then recorded. RESULTS: mean age was 80.9 years with a male:female ratio of 27:74. The mean predicted abbreviated mental test score was 6.57 (SD 2.9); the mean actual abbreviated mental test score being 6.36 (SD 3.2). Comparing the two groups, abbreviated mental test scores were predicted most accurately at the extremes and correlation between the two groups of scores was high (P<0.001 Spearman test). Kappa statistics revealed moderate agreement between the two groups, (0.56, 95% CI 0.48-0.63). A predicted score of 5/10 showed the greatest spread of true abbreviated mental test scores (0-10, mean 4.5). However in total, only 31% of the predicted abbreviated mental test scores were accurate, with 42% being incorrect by >1. Using the accepted cut-off of <7/10, this revealed that 13% were underdiagnosed and 19% were overdiagnosed as being cognitively impaired. CONCLUSIONS: clinicians are poor at predicting abbreviated mental tests in the midrange but are more accurate at predicting lower and higher scores. This descriptive study reinforces the importance of using an objective assessment of cognitive impairment rather than clinicians estimating its presence or absence.
OBJECTIVE: To determine the relationship between Abbreviated Mental Test (AMT) and the Mini-Mental State Examination (MMSE) in elderly patients admitted to hospital. DESIGN: Prospective study of 364 consecutive admissions to an elderly medicine unit. Eighty-eight (24.2%) patients were excluded. The AMT and MMSE were administered to the remaining 276 patients and the relationship between the two tests evaluated statistically. SETTING: Inner city teaching hospital. SUBJECTS: Two hundred and seventy-six patients admitted to the elderly medicine unit during October and November 1997. MAIN OUTCOME MEASURES: Predictive efficiency of the AMT for cognitive state by MMSE (the percentage of patients whose cognitive state by the MMSE was correctly categorized by the AMT). Association and predictive relationship between individual AMT and MMSE scores. RESULTS: There was a significant relationship between cognitive state as determined by the AMT and MMSE: chi2 = 101.3, df = 1, p <0.001. The predictive efficiency of the AMT was 79.0% (218/276). A strong association was found between the AMT and MMSE (Somers' d statistic 0.75: p <0.001). Simple linear regression allowed prediction of the MMSE score from the AMT score as follows: MMSE score = 7.06 + (1.94 x AMT score); p <0.001. CONCLUSIONS: In patients admitted to the elderly medicine unit, the AMT gave predictive information about cognitive status as determined by the MMSE, and also a prediction of likely MMSE score.
The usefulness, inter-rater reliability, and validity of six mental tests, the MMS, the GMS, the MSQ, the VRT, the OLT, and the DCT were studied in 81 patients over the age of 75 years. The patients were classified as being mentally impaired or unimpaired by psychogeriatric assessment. All tests had high reliability. The MMS, GMS, MSQ, and OLT were the most feasible and useful. The tests were validated by logistic regression analysis and the most efficient were the MMS, GMS, and OLT. Improvement was achieved when two or all three tests were used simultaneously. The three tests seem to be suitable tools for the detection of mental failure in patients of old age.
Especially in outpatient settings, dementia is still an underdiagnosed syndrome. The Micro-Mental Test has been developed as a short version of the Mini-Mental-Status Examination (MMSE). We examined the reliability and diagnostic validity of a German version (Mikro-Mental Test). We administered the MMSE and the German version of the Micro-Mental Test to 20 inpatients of a geriatric psychiatry hospital (mean age 74.8+/-8.1 years), 55 patients from a cognitive clinic (mean age 71.9+/-9.1 years), and 27 healthy older adults (mean age 68.5+/-4.1 years). Diagnoses made by an experienced psychiatrist according to ICD-10 criteria served as external criteria. The mean duration for testing with the Micro-Mental Test was 8 min, and with the MMSE 15 min. Test-retest analyses showed satisfactory reliability. With regard to sensitivity and specificity, we found comparable diagnostic validity for the MMSE and the Micro-Mental Test. We suggest that, due to its brevity and diagnostic validity, the Micro-Mental Test is a useful tool for dementia screening in an outpatient setting.
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OBJECTIVE: To determine whether a shortened version of the Abbreviated Mental Test is as effective as the Abbreviated Mental Test (AMT) itself in assessing cognition in elderly patients. DESIGN: A shortened four-item version of the Abbreviated Mental Test (AMT4) was constructed using the following items: (1) Age, (2) Date of birth, (3) Place, and (4) Year, with impaired cognition indicated by an AMT4 score of less than four. Patients were assessed with the AMT. 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). SETTING: Inner-city teaching hospital. SUBJECT: Two hundred consecutive elderly patients seen on domiciliary visits, in the clinic or as orthogeriatric referrals. RESULTS: The AMT4 score 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. CONCLUSIONS: The AMT4 may be useful in the initial assessment of cognition in elderly patients, with little loss of accuracy in detecting marked cognitive impairment when compared to the AMT.
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Adverse effects of Schistosoma haematobium infection on mental activities were studied at a primary school in rural Kenya, where the intensity of infection was light (the average egg count: < 50/10 ml of urine). The school children received three kinds of mental tests, which examine attentiveness and concentration, before and a month after treatment with a single dose of praziquantel. A pretreatment analysis showed that test scores became worse as egg counts of children increased. The praziquantel treatment improved the scores of all three tests among children who got high scores in the first tests. The study showed that even the light infection caused adverse effects on mental activities, which were detectable using simple mental tests.
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The validity of the Abbreviated Mental Test was demonstrated by comparison with final clinical diagnoses in a consecutive sample of 168 patients admitted with acute illness to a department of health care of the elderly. Fifty-eight (34%) had abnormal cognition. The best cut-off point was 8, with less than 8 suggesting abnormal cognitive function. A short version (the AMT7) of the AMT was developed. Its validity, internal consistency and coverage of domains was equivalent to the AMT but it had a slightly higher sensitivity (with acceptable specificity) than the original. This new short version may improve performance of junior doctors in clinical practice who appear to have difficulty remembering all 10 items of the AMT.
Sex differences in central tendency, variability, and numbers of high scores on mental tests have been extensively studied. Research has not always seemed to yield consistent results, partly because most studies have not used representative samples of national populations. An analysis of mental test scores from six studies that used national probability samples provided evidence that although average sex differences have been generally small and stable over time, the test scores of males consistently have larger variance. Except in tests of reading comprehension, perceptual speed, and associative memory, males typically outnumber females substantially among high-scoring individuals.
We investigated the validity of the abbreviated mental test (AMT) as a guide to the diagnosis of delirium in 100 patients aged more than 65 yr. Patients were assessed using the AMT on the day before and on the third day after operation. Fifteen patients were delirious on the third postoperative day; 10 of 43 patients undergoing orthopaedic surgery and five of 57 patients undergoing non-orthopaedic surgery. Delirium developed in four of 16 patients with a preoperative AMT score less than 8 and in 11 of 84 patients with a preoperative AMT score of 8 or more. Patients who developed delirium had a greater decline in AMT score (mean 2.7 (SD 0.9)) than patients who did not develop delirium (0.7 (1.0)) (P < 0.001). The sensitivity and specificity of a decline in AMT score of 2 or more points after surgery for diagnosis of postoperative delirium were 93% and 84%, respectively.
OBJECTIVES: To evaluate validity and internal structure of the Abbreviated Mental Test (AMT), and to assess the dependence of the internal structure upon the characteristics of the patients examined. DESIGN: Cross-sectional examination using data from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA) database. SETTING: Twenty-four acute care wards of Geriatrics or General Medicine. PARTICIPANTS: Two thousand eight hundred and eight patients consecutively admitted over a 4-month period. MEASUREMENTS: Demographic characteristics, functional status, medical conditions and performance on AMT were collected at discharge. Sensitivity, specificity and predictive values of the AMT <7 versus a diagnosis of dementia made according to DSM-III-R criteria were computed. The internal structure of AMT was assessed by principal component analysis. The analysis was performed on the whole population and stratified for age (<65, 65-80 and >80 years), gender, education (<6 or >5 years) and presence of congestive heart failure (CHF). RESULTS: AMT achieved high sensitivity (81%), specificity (84%) and negative predictive value (99%), but a low positive predictive value of 25%. The principal component analysis isolated two components: the former component represents the orientation to time and space and explains 45% of AMT variance; the latter is linked to memory and attention and explains 13% of variance. Comparable results were obtained after stratification by age, gender or education. In patients with CHF, only 48.3% of the cumulative variance was explained; the factor accounting for most (34.6%) of the variance explained was mainly related to the three items assessing memory. CONCLUSION: AMT >6 rules out dementia very reliably, whereas AMT <7 requires a second level cognitive assessment to confirm dementia. AMT is bidimensional and maintains the same internal structure across classes defined by selected social and demographic characteristics, but not in CHF patients. It is likely that its internal structure depends on the type of patients. The use of a sum-score could conceal some part of the information provided by the AMT.
OBJECTIVE: To measure the abbreviated mental test (AMT)-and to determine factors which might influence this in a group of Zimbabwean elders. DESIGN: Community based cross sectional survey. SETTING: Randomly selected households within randomly selected villages and two high-density urban areas in north eastern Zimbabwe. SUBJECTS: 278 subjects aged 60 to 92 years (124 male, 154 female). INTERVENTIONS: A questionnaire, including the AMT, was administered, at home, by trained research nurses. MAIN OUTCOME MEASURES: AMT-literacy rates, visual acuity, social and demographic information. RESULTS: 128 (46pc) scored less than seven, a level normally associated with significant mental impairment. Only one subject was actually disoriented in time and place. Multiple regression analysis confirmed that increasing age, female sex, rural evidence, lack of formal education, reduced visual acquity and not currently living with a spouse were all independent factors associated with low AMT score. CONCLUSION: It was apparent that the AMT was not a valid tool for screening for confusion in Zimbabwean elderly, since the prevalence of senile-dementia is increasing in the developing world. It is important to develop a screening test for use in Zimbabwe which is sensitive but is independent of these confounding variables.
We investigated the accuracy of the Hodkinson abbreviated mental test (AMT) as a screening instrument for dementia in an Italian population. The AMT was administered by nonmedical personnel to 124 subjects > 59 years old. Each subject independently underwent a clinical evaluation for dementia (DSM-III criteria), and scores on the AMT were compared to corresponding clinical diagnoses (standard for comparison). Twenty of the 124 subjects were found to be affected by dementia upon clinical investigation. Although a score of 6 on the AMT showed the best combination of sensitivity (90%) and specificity (89%), only a score of 7 yielded 100% sensitivity (71% specificity). Specificity was higher in men, younger, and more educated subjects.