Cognitive assessment in elderly patients admitted to hospital: the relationship between the Abbreviated Mental Test and the Mini-Mental State Examination

Abstract

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:² = 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 × 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.

Get full access to this article

View all access options for this article.

References

Hodkinson HM . Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 1972; 1: 233–238.

Working Group of the Royal College of Physicians and the British Geriatrics Society. Standardised assessment scales for elderly people. London: Royal College of Physicians, 1992.

Wilcock GK , Ashworth DL , Langfield JA , Smith PM . Detecting patients with Alzheimer's disease suitable for drug treatment: comparison of three methods of assessment. Br J Gen Pract 1994; 44: 30–33.

Vardon VM , Blessed G . Confusion ratings and abbreviated mental test performance: a comparison. Age Ageing 1986; 15: 139–144.

Brocklehurst JC , Carty MH , Leeming JT , Robinson JM . Medical screening of old people accepted for residential care. Lancet 1978; ii: 141–143.

Bigler D , Adelhøj B , Petring OU , Pederson NO , Busch P , Kalhke P . Mental function and morbidity after acute hip surgery during spinal and general anaesthesia. Anaesthesia 1985; 40: 672–676.

Jitapunkul S , Pillay I , Ebrahim S . The abbreviated mental test: its use and validity. Age Ageing 1991; 20: 332–336.

Rocca WA , Bonaiuto S , Lippi A et al. Validation of the Hodkinson abbreviated mental test as a screening instrument for dementia in an Italian population. Neuroepidemiology 1992; 11: 288–295.

Jitapunkul S , Pillay I , Ebrahim S . Delirium in newly admitted elderly patients: a prospective study. Q J Med 1992; 300: 307–314.

10.

Ames D , Flicker L , Helme RD . A memory clinic at a geriatric hospital: rationale, routine and results from the first 100 patients. Med J Aust 1992; 156: 618–622.

11.

Gale CR , Martyn CN , Cooper C . Cognitive impairment and mortality in a cohort of elderly people. BMJ 1996; 312: 608–611.

12.

Folstein MF , Folstein SE , McHugh PR . Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198.

13.

Tombaugh TN , McIntyre NJ . The Mini-Mental State Examination: a comprehensive review. J Am Geriatr Soc 1992; 40: 922–935.

14.

MacKenzie DM , Copp P , Shaw RJ , Goodwin GM . Brief cognitive screening of the elderly: a comparison of the Mini-Mental State Examination (MMSE), Abbreviated Mental Test (AMT) and Mental Status Questionnaire (MSQ). Psychol Med 1996; 26: 427–430.

15.

Eagger SA , Levy R , Sahakian BJ . Tacrine in Alzheimer's disease. Lancet 1991; 337: 989–992.

16.

Somers RH . A new asymmetric measure of association for ordinal variables. Am Sociol Rev 1962; 27: 799–811.

17.

O'Neill D , O'Shea B , Walsh JB , Coakley D . Screening for dementia and delirium using an adapted Folstein mini-mental state examination. Ir Med J 1989: 82: 24–25.

18.

Fields SD , MacKenzie CR , Charlson ME , Sax FL . Cognitive impairment. Can it predict the course of hospitalised patients? J Am Geriatr Soc 1986; 34: 579–585.