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Printed on 7/20/2026
For informational purposes only. This is not medical advice.
The Abbreviated Mental Test Score (AMTS) is a classic 10-item bedside cognitive screen used in geriatric and acute-care workflows. Each correct response scores 1 point (total 0-10). Lower scores indicate greater cognitive concern.
Formula: AMTS total = number of correct responses across 10 items (0-10).
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The standard Hodkinson AMTS-10 asks 10 questions: (1) How old are you? (2) What is the time (to the nearest hour)? (3) Give the patient an address to remember and recall at the end of the test (e.g., 42 West Street). (4) What year is it? (5) What is the name of the place where you are now? (6) Can the patient recognize two people around them? (7) What is your date of birth (day and month)? (8) In what year did World War I begin (or end)? (9) What is the name of the current monarch (or president, or prime minister)? (10) Count backward from 20 to 1. Each question has a simple correct or incorrect scoring — no partial credit. The address given in question 3 is recalled at the end of the test as the 10th question.
Score each item 1 for a correct response or 0 for an incorrect or absent response. For the time question, answers within 1 hour of the correct time are accepted as correct. For counting backward from 20 to 1, one error is accepted. For the current year, exact year is required. For recognizing two people, the patient must correctly identify two people in their vicinity (examiner, nurse, ward staff, family). For the address recall, exact recall of all elements (number, street name, city) is typically required, though some adaptations accept partial recall. Sum the 10 items for the AMTS total (0 to 10).
Interpret AMTS using established clinical bands: 8 to 10 = normal; 7 = borderline (monitor, consider re-assessment); 4 to 6 = moderate cognitive impairment consistent with significant concern; 0 to 3 = severe cognitive impairment. In clinical practice, an AMTS below 8 is the most widely used concern threshold, and AMTS of 6 or below is more specific for significant cognitive impairment. A score of 7 or below in the absence of acute confusion should trigger comprehensive cognitive assessment. The AMTS is also sensitive to delirium — an acute drop from the patient's baseline AMTS is a red flag for superimposed delirium regardless of the absolute score.
Admitting nurses, hospitalists, geriatric liaison teams, emergency nurses
The AMTS-10 is routinely used for cognitive baseline assessment at hospital admission in older adults across the UK and many Commonwealth health systems. It is embedded in hospital admission pro-formas and nursing care plans as a standard component of the nursing assessment. AMTS at admission establishes a cognitive baseline for detecting superimposed delirium during the hospital stay, guides safety planning (fall risk, medication self-management), informs communication strategies, and identifies patients who benefit from early geriatric consultation. Patients with AMTS below 8 at admission benefit from enhanced orientation support, simplified medication regimes, and regular cognitive monitoring during the stay.
Emergency physicians, emergency nurses, rapid assessment teams
The AMTS is one of the most practical cognitive screening tools for the emergency setting due to its 3 to 5 minute verbal administration, no equipment requirements, and no special training needs. In older adults presenting to the ED with confusion, falls, or other acute presentations, the AMTS provides rapid cognitive triage. An AMTS below 8 in the acute setting indicates cognitive impairment that may reflect delirium, dementia, or both, and warrants structured delirium assessment (4AT, CAM), medical workup for acute precipitants, and adjusted patient management (fall risk, medication review, family notification). AMTS serial measurement during an ED stay tracks cognitive trajectory.
Anesthesiologists, surgical nurses, preoperative assessment teams
Preoperative AMTS-10 provides a validated cognitive baseline before elective surgery in older adults. A preoperative AMTS below 8 identifies patients at elevated risk for postoperative delirium, prolonged hospital stay, and cognitive complications. Establishing a documented preoperative AMTS baseline enables accurate detection of cognitive change in the postoperative period — comparing postoperative AMTS to preoperative baseline is more informative than a single postoperative assessment in isolation. For same-day surgery admission, AMTS can be rapidly obtained in the preoperative assessment clinic, enabling proactive delirium prevention planning.
Medical and surgical nurses, ward physicians, geriatric liaison teams
The AMTS is effective for rapid cognitive monitoring in acutely unwell older adults, enabling serial assessment to track delirium onset, progression, and resolution. Nursing staff can administer the AMTS at shift handover or when confusion is suspected, providing objective cognitive data that supplements clinical observation. An acute drop in AMTS from the patient's documented baseline — even if the absolute score is still in the normal range — is a clinically significant finding that warrants delirium assessment and investigation for precipitating causes. The AMTS can be combined with the [4AT delirium screen](/tools/4at-delirium) for comprehensive delirium detection.
Community geriatricians, care home nurses, community nurses, general practitioners
The AMTS is widely used in UK community geriatric practice, care home assessments, and GP cognitive screening. Its brief administration without any specialist equipment makes it practical in home visits, nursing home assessments, and community clinic settings. For care home residents, serial AMTS monitoring detects acute deterioration that warrants medical assessment. In community cognitive screening, AMTS below 8 prompts referral for comprehensive assessment. The AMTS is included in the UK's NICE dementia guidelines as an acceptable brief cognitive screen for GP use in primary care.
The original Hodkinson AMTS uses 'In what year did World War I begin?' (1914). In jurisdictions where WWI dates are not part of standard education, this question can be adapted to a locally significant historical event with a specific, known date (e.g., year of major historical event, year of moon landing in 1969). Document any adaptations made to ensure consistent application and valid serial comparisons. The key principle is that the question tests access to remote, crystallized historical memory.
The address (e.g., 42 West Street) given at the beginning of the AMTS serves as a delayed recall item, tested at the end of the assessment after 5 to 10 minutes and 9 other items have been completed. The delay and interference from the intervening items make this a genuine test of short-term memory consolidation rather than immediate repetition. Ensure the address is presented at the START of the AMTS and that the patient is asked to recall it at the END, not immediately after hearing it.
The time question accepts answers within 1 hour of the actual time as correct. A patient answering 2pm when it is 2:30pm scores correct (30 minutes within). A patient answering 3pm when it is 2:30pm scores incorrect (60 minutes off — the boundary case). Always check the actual current time before administering and document it. Time orientation is more error-prone in hospital environments where day-night cycles are disrupted and external time cues are reduced.
The standard AMTS scoring allows the patient one error in counting backward from 20 to 1. A patient who makes one correction or one mistake but continues appropriately and completes the count should score 1 (correct). Two or more errors score 0. This tolerance for one error reflects the high variability in counting accuracy in normal older adults under cognitive stress. If the patient refuses to attempt counting backward, score 0 and document the refusal.
An acute drop in AMTS from the patient's documented baseline is one of the most important clinical signals in hospital practice. A patient with baseline AMTS of 9 who scores 4 on day 3 of admission has very likely developed delirium, even if the absolute score of 4 alone might suggest moderate dementia in a different context. Always compare current AMTS to documented baseline — the magnitude of change from baseline is often more clinically informative than the absolute score.
The AMTS is sensitive to cognitive impairment from any cause — dementia, delirium, acute metabolic disturbance, or medication effects. A low AMTS does not distinguish delirium from dementia by itself. When cognitive impairment is detected by AMTS in an acutely unwell patient, always assess for delirium using the [4AT](/tools/4at-delirium) or CAM before concluding that the impairment reflects chronic dementia. The fluctuating course and acute onset components of delirium assessment (which the AMTS does not capture) are essential for delirium-dementia differentiation.
The person recognition item asks the patient to correctly identify two people in their environment. In hospital settings, this typically means the examiner and a nurse or healthcare worker whose identity has been clearly communicated to the patient. In community or care home settings, the patient may identify family members. The recognition test taps semantic memory for recently encountered faces and is specifically sensitive to temporal lobe dysfunction. Ensure the test persons are clearly identified (introduce them by name and role) before testing recognition.
The AMTS threshold of below 8 has high sensitivity (catches most cognitively impaired patients) but lower specificity (some normal older adults score 7, particularly in hospitals, emergency settings, or under stress). A threshold of below 7 (6 or less) is more specific for true cognitive impairment and reduces false positives. In clinical practice, apply AMTS 7 as a monitor-and-reassess threshold, and AMTS 6 or below as a more definitive signal requiring immediate comprehensive cognitive and delirium assessment.
The AMTS provides a quick cognitive screen but does not capture executive function, language, or visuospatial domains affected in non-Alzheimer's dementias and frontal lobe syndromes. A patient with behavioral variant FTD may score 9 or 10 on AMTS despite significant dementia because their orientation and remote memory are preserved. In patients with suspected dementia where AMTS appears normal but clinical concern persists, supplement with MoCA, SLUMS, or full neuropsychological assessment that specifically tests frontal-executive function.
AMTS has been used for decades as a practical 10-item cognitive screen, with broad adaptation across healthcare settings.
Lower AMTS scores indicate greater cognitive impairment signal and support follow-up diagnostic evaluation.
Use as a rapid bedside cognitive triage screen when short administration time is required.
Scores may be affected by education, language, sensory impairment, and acute illness/delirium; AMTS alone is not diagnostic.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · trust-baseline
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