Abbreviated Mental Test Score (AMTS)

Background

The Abbreviated Mental Test Score (AMTS) is a rapid ten-item screen for cognitive impairment, designed for use in older adults. Each correct answer scores one point, giving a total out of 10. The items test orientation, registration and recall (an address), long-term memory (date of birth, a historical date, recognising the current monarch or leader), and attention (counting backwards from 20 to 1). It was developed for quick bedside use and is widely employed on acute medical and geriatric wards as a first-pass screen.

Interpreting the result

A score of 9 or 10 is regarded as normal. A score of 7 or 8 is borderline and warrants attention, particularly if it represents a change. A score of 6 or below suggests cognitive impairment and should prompt further assessment, including consideration of delirium, dementia or an acute medical cause. The AMTS is a screen, not a diagnostic test: an abnormal score indicates the need for fuller evaluation rather than confirming a specific diagnosis.

Worked example

An older patient admitted acutely correctly states their age, the year and the name of the hospital, recognises two staff members, and counts backwards from 20, but cannot recall the address, the time, their date of birth, the current monarch or a historical date — scoring 5 out of 10. This is below 7, suggesting cognitive impairment and prompting assessment for delirium and a fuller cognitive review.

Pearls / pitfalls

• A single low score does not distinguish delirium from dementia — always assess for an acute, reversible cause (the 4AT is useful for delirium specifically).
• Sensory impairment, language barriers, anxiety and unfamiliarity with the questions can lower the score independently of true cognitive impairment.
• It is a screen, not a diagnosis — an abnormal result triggers further evaluation, not a label.
• Track scores over time and against a known baseline where possible; a fall from baseline is more informative than any single value.

Evidence & validation

Derived by Hodkinson in 1972 from a longer mental test battery to provide a brief, practical screen for the elderly, the AMTS remains in routine UK use and is referenced in delirium and dementia assessment pathways, often as a first-line screen alongside tools such as the 4AT.

Frequently asked questions

References

1. Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing. 1972;1(4):233–238.
2. NICE NG97: Dementia: assessment, management and support for people living with dementia and their carers. 2018.

Related calculators