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

Abstract

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.