Screening for cognitive impairment in older people attending accident and emergency using the 4-item Abbreviated Mental Test

Schofield, Irene; Stott, David J.; Tolson, Debbie; McFadyen, Angus; Monaghan, James; Nelson, Derek

doi:10.1097/mej.0b013e32833777ab

Cited by 53 publications

(32 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Item 1 assesses level of alertness [12]. The next two items are brief cognitive screening tests: the Abbreviated Mental Test—4 (AMT4) [13], and attention testing with Months Backwards [14]. Item 4 assesses acute change or fluctuation in mental status [1].…”

Section: Methodsmentioning

confidence: 99%

Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people

Morandi²,

et al. 2014

View full text Add to dashboard Cite

Objective: to evaluate the performance of the 4 ‘A’s Test (4AT) in screening for delirium in older patients. The 4AT is a new test for rapid screening of delirium in routine clinical practice.Design: prospective study of consecutively admitted elderly patients with independent 4AT and reference standard assessments.Setting: an acute geriatrics ward and a department of rehabilitation.Participants: two hundred and thirty-six patients (aged ≥70 years) consecutively admitted over a period of 4 months.Measurements: in each centre, the 4AT was administered by a geriatrician to eligible patients within 24 h of admission. Reference standard delirium diagnosis (DSM-IV-TR criteria) was obtained within 30 min by a different geriatrician who was blind to the 4AT score. The presence of dementia was assessed using the Alzheimer's Questionnaire and the informant section of the Clinical Dementia Rating scale. The main outcome measure was the accuracy of the 4AT in diagnosing delirium.Results: patients were 83.9 ± 6.1 years old, and the majority were women (64%). Delirium was detected in 12.3% (n = 29), dementia in 31.2% (n = 74) and a combination of both in 7.2% (n = 17). The 4AT had a sensitivity of 89.7% and specificity 84.1% for delirium. The areas under the receiver operating characteristic curves for delirium diagnosis were 0.93 in the whole population, 0.92 in patients without dementia and 0.89 in patients with dementia.Conclusions: the 4AT is a sensitive and specific method of screening for delirium in hospitalised older people. Its brevity and simplicity support its use in routine clinical practice.

show abstract

Section: Methodsmentioning

confidence: 99%

Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people

Morandi²,

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The weighted mean prevalence of dementia was 30.7% and ranged from 12% in Barbic et al . to 43% in Schofield et al . Wilding et al .…”

Section: Resultsmentioning

confidence: 93%

“…A total of 1,616 unique citations were identified through a search of PubMed, EMBASE, CINAHL, CENTRAL, and DARE and 1,588 were excluded after review of their title and abstract revealed inapplicability to our inclusion criteria. A total of 16 studies underwent full‐text review and nine were included in the current analysis (Figure ) . The seven excluded studies enrolled duplicate patients, provided insufficient details to reconstruct two‐by‐two tables, or did not assess a brief screening instrument .…”

Section: Resultsmentioning

confidence: 99%

“…Blinding to the reference standard for the individual interpreting the index test was uncertain or inadequate in four studies, while blinding to the index test by the reference standard evaluator was inadequate in six studies. The reference standard was the MMSE for all but two studies, but the threshold to differentiate “dementia” from “no dementia” was ≤ 23 in five studies and ≤ 24 in two studies . The other two studies used MMSE in combination with other instruments and assessments as the reference standard for dementia as detailed in Table .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Carpenter

Banerjee

Keyes

et al. 2018

Academic Emergency Medicine

View full text Add to dashboard Cite

ED-based diagnostic research for dementia screening is limited to a few studies using an inadequate criterion standard with variable masking of interpreter's access to the index test and the criterion standard. Standardizing the geriatric ED cognitive assessment methods, measures, and nomenclature is necessary to reduce uncertainties about diagnostic accuracy, reliability, and relevance in this acute care setting. The AMT-4 is currently the most accurate ED screening instrument to increase the probability of dementia and the Brief Alzheimer's Screen is the most accurate to decrease the probability of dementia. Dementia screening as one marker of vulnerability to initiate comprehensive geriatric assessment is warranted based on test-treatment threshold calculations.

show abstract

“…17 These direct cognitive tests are commonly used in UK hospital practice and have been validated in acute care settings. 17 The clock drawing test (CDT) was scored using a 0-to 3-point method. This direct screening test does not require verbal output and has been suggested as suitable for use in stroke.…”

Section: Assessmentsmentioning

confidence: 99%

Test Accuracy of Short Screening Tests for Diagnosis of Delirium or Cognitive Impairment in an Acute Stroke Unit Setting

Lees

Corbet

Johnston

et al. 2013

Stroke

View full text Add to dashboard Cite

Background and Purpose-Guidelines recommend cognitive screening in acute stroke. Various instruments are available, with no consensus on a preferred tool. We aimed to describe test accuracy of brief screening tools for diagnosis of cognitive impairment and delirium in acute stroke. Methods-We collected data on sequential stroke unit admission in a single center. Four assessors trained in cognitive testing independently performed screening and reference tests. Brief assessments comprised the following: 10-and 4-point Abbreviated Mental Test (AMT-10; AMT-4); 4-A Test (4AT); Clock Drawing Test (CDT); Cog-4; and Glasgow Coma Scale (GCS). We also recorded the multidisciplinary team's informal review using single question (SQ). We compared against reference standards of Montreal Cognitive Assessment (MoCA) and Confusion Assessment Method for delirium using usual diagnostic cutpoints. For MoCA, we described effects of lowering the diagnostic threshold to MoCA <24 and MoCA <20. We described sensitivity, specificity, and positive and negative predictive values. Results-Over a 10-week period, 111 subjects had cognitive assessment data. Subjects were 50% male (n=55), and median age was 74 years (interquartile range, 64-85). AMT-4, AMT-10, and SQ all had excellent (1.00) specificity for detection of cognitive impairment, although sensitivity was poor (all <0.60). The 4AT had greatest sensitivity for detecting delirium (

show abstract

Screening for cognitive impairment in older people attending accident and emergency using the 4-item Abbreviated Mental Test

Cited by 53 publications

References 9 publications

Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people

Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people

Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Test Accuracy of Short Screening Tests for Diagnosis of Delirium or Cognitive Impairment in an Acute Stroke Unit Setting

Contact Info

Product

Resources

About