title: Routine cognitive screening in older patients admitted to acute medicine: abbreviated mental test score (AMTS) and subjective memory complaint versus Montreal Cognitive Assessment and IQCODE.
abstract: BACKGROUND
  Routine cognitive screening for in-patients aged ≥75 years is recommended, but there is uncertainty around how this should be operationalised. We therefore determined the feasibility and reliability of the Abbreviated mental test score (AMTS/10) and its relationship to subjective memory complaint, Montreal Cognitive Assessment (MoCA/30) and informant report in unselected older admissions.
  
  
  METHODS
  Consecutive acute general medicine patients aged ≥75 years admitted over 10 weeks (March-May 2013) had AMTS and a question regarding subjective memory complaint (if no known dementia/delirium). At ≥72 h, the 30-point Montreal Cognitive Assessment (MoCA) and Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) were done. Cognitive impairment was defined as AMTS < 9 or MoCA < 26 (mild impairment) and MoCA < 20 (moderate/severe impairment) or IQCODE ≥ 3.6.
  
  
  RESULTS
  Among 264 patients (mean age/SD = 84.3/5.6 years, 117 (44%) male), 228 (86%) were testable with AMTS. 49/50 (98%) testable patients with dementia/delirium had low AMTS compared with 79/199 (44%) of those without (P < 0.001). Subjective memory complaint agreed poorly with objective cognitive deficit (39% denying a memory problem had AMTS < 9 (kappa = 0.134, P = 0.086)) as did informant report (kappa = 0.18, P = 0.15). In contrast, correlation between AMTS and MoCA was strong (R2 = 0.59, P < 0.001) with good agreement between AMTS < 9 and MoCA < 20 (kappa = 0.50, P < 0.01), although 85% of patients with normal AMTS had MoCA < 26.
  
  
  CONCLUSIONS
  The AMTS was feasible and valid in older acute medicine patients agreeing well with the MoCA albeit with a ceiling effect. Objective cognitive deficits were prevalent in patients without known dementia or delirium but were not reliably identified by subjective cognitive complaint or informant report.
authors.affiliation: Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, UK NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK Departments of Medicine and Geratology, John Radcliffe Hospital, Oxford, UK.
authors.forename: S T
authors.initials: ST
authors.lastname: Pendlebury
authors.affiliation: NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK Departments of Medicine and Geratology, John Radcliffe Hospital, Oxford, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Klaus
authors.affiliation: NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK Departments of Medicine and Geratology, John Radcliffe Hospital, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Mather
authors.affiliation: NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK Departments of Medicine and Geratology, John Radcliffe Hospital, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: de Brito
authors.affiliation: Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Wharton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis*; D003693:Delirium / Q000175:diagnosis; D003704:Dementia / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008569:Memory Disorders / Q000175:diagnosis*; D009483:Neuropsychological Tests; D010343:Patient Admission / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: AMTS; IQCODE; Montreal Cognitive Assessment; cognitive screening; older people; subjective memory complaint