The AMT

 I have chosen to do a quick mid-week update just to review a topic raised in my work experience, which I have been lucky enough to have this week. I shadowed an orthopaedic house officer on a hectic on-call seeing lots of elderly hip facture patients. After checking the patient’s Xrays the doctor went to see each patient and did the AMT (Abbreviated Mental Test). This is a speedy check of metal functions to check for any confusion, delirium or dementia in elderly patients. Over the course of the day we saw a range of patients with AMT score from the maximum 10/10 to patients too confused, deaf or ill to take the test.

 The test consist of 10 questions, each worth one point, delivered in roughly this order:

1)    What is your date of birth?

2)     So how old does that make you?

3)     Can you tell me where you are at the moment? (hospital name, ward name, city etc.)

4)     What year is it at the moment?

5)  What did I say my job was? (expecting an answer of doctor or similar)

   Then: Can you just remember this address and repeat it back to me? (Say an address twice such as “42 West Street”. Then say that you will ask for that address again later.)

6     When was the start of the First World War?  (Embarrassingly I failed this one but through lack of historic interest more than any long term memory problem)

7)    Can you tell me who the monarch is at the moment? (can substitute prime minister ect. but no one too obscure)

8)    Can you count backwards from 20 to 1 please?

9)      What time of day would you say it is now? (answer to nearest hour or so)

10   Can you just tell me that address I told you earlier?

 The advantage of the AMT test is that is that it can be done very quickly and can give a very rough idea of the patient’s metal functions that can be followed up if necessary. A score below 7/10 may suggest cognitive impairment of some kind. The test also has the advantage of well received by both doctors and patients.

 However inconsistencies in the way the test is given and marked make it unreliable in some cases. Many doctors chose to omit some of the questions such as asking for date of birth and some incorrectly try to introduce half-marks. Consequently patients with the same mental state may have wildly different AMT scores. Also the test may not be valid in ethnic minorities due to some culturally specific questions like asking for the date of the First World War. The test is also going to require changing as questions such as the monarch and early 20^th century history become may become less significant information to people so are less likely to be known not for a metal problem but for lack of cultural value. Another big problem is the patient’s physical state at the time of the test. Simple factors such as dehydration, tiredness or hunger may affect the AMT score giving anomalous results. Despite all these faults the test is still likely to be used (possibly in an adapted form) due to its speed and efficiency in evaluating mental state.