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Obituary
The Abbreviated Mental Test (1972 - 2006)

It is with sadness that we announce the passing of an old friend.

The AMT was born at a time when geriatric medicine was coming of age, moving from being predominantly a rehabilitation specialty to managing older people presenting with acute illnesses. It was a time when geriatricians were developing evidence-based approaches to the geriatric giants. The AMT was born to aid the recognition of one of these giants - confusion, by quantifying cognitive impairment at the bedside. It has served this purpose for over thirty years.

A number of younger siblings have followed the AMT over the years and one of these, the MMSE, has come to overshadow it. Sadly, in its later years the frailty of the AMT became increasingly evident, largely due to its significant cultural loading that rendered it invalid in a multi-cultural society. In 1972 most of the people being administered the AMT would have been alive at the start of World War 1, but this generation has almost faded away now; substituting the years of World War 2 has never been validated as equivalent.

Sample AMT

1. Age
2. Time (to nearest hour)
3. Address (42 West Street) – check at end
of test
4. Month
5. Year
6. Name of hospital
7. Date of Birth
8. Start of World War 1
9. Name of present monarch
10. Count backwards 20 - 1

Delirious about dementia
And so we in the British Geriatrics Society have to say adieu to the AMT, but its memory lingers on in the continued approach to quantitative cognitive screening in the new guidelines, ‘Delirious about Dementia’. Now, alongside the MMSE that has already been adopted by our colleagues in old age psychiatry, we also have a clock-drawing test, the CLOX-1. Furthermore, there is an algorithm that takes the clinician on from a positive screen for cognitive impairment to the diagnosis of delirium and/or dementia. The new guidelines were brought to life in a popular satellite symposium at this April’s BGS Scientific Meeting, but the consensus group under the aegis of the Cerebral Ageing and Mental Health SIG are very keen to hear what further educational support will aid their implementation. Ideas ranging from a DVD demonstrating how to administer the tests, a CD-ROM with printable versions of the tests, to local educational meetings are under consideration. We are keen for people to e-mail us with their thoughts so that as we say goodbye to the AMT we can go forward with confidence saying,

‘Cognitive screening is dead. Long live cognitive screening!’

John Starr
Alasdair MacLullich