What is the Abbreviated Mental Test Score (AMTS-10)?

The AMTS-10 is a validated 10-item bedside cognitive screen developed by Hodkinson in 1972, widely used in UK and Commonwealth clinical practice. It assesses orientation, memory, and concentration through 10 questions. Each correct response scores 1 point (total 0 to 10). It takes 3 to 5 minutes to administer verbally at the bedside with no equipment required.

How are AMTS scores commonly interpreted?

Standard score bands: 8 to 10 = normal; 7 = borderline (monitor and reassess); 4 to 6 = moderate cognitive impairment; 0 to 3 = severe cognitive impairment. A score of below 8 is the most widely used concern threshold. Score of 6 or below is more specific for significant cognitive impairment. Always interpret in context of acute illness, baseline cognitive status, and patient history.

Can AMTS diagnose dementia?

No. The AMTS is a screening tool, not a diagnostic test. A score below 8 identifies patients who need comprehensive cognitive assessment — the dementia diagnosis requires detailed cognitive testing, functional assessment, clinical history, and exclusion of reversible causes including delirium, metabolic disturbances, and medication effects.

Where is AMTS most used?

AMTS is most widely used in the UK and Commonwealth health systems (Australia, New Zealand, Canada, parts of Asia). It is embedded in UK hospital nursing admission protocols, emergency department assessments, and primary care cognitive screening. It is included in NICE dementia guidelines as an acceptable brief cognitive screen.

Is AMTS valid for detecting delirium?

The AMTS is sensitive to acute cognitive change caused by delirium — serial AMTS monitoring can detect delirium onset as an acute score drop from baseline. However, the AMTS does not distinguish delirium from dementia by itself. For formal delirium screening, use the [4AT delirium screen](/tools/4at-delirium) or CAM, which specifically assess delirium features including fluctuation, acute onset, and inattention.

What AMTS score indicates normal cognition?

A score of 8 to 10 is generally considered normal. Scores of 9 to 10 are characteristic of intact cognitive function. A score of 8 may be normal, particularly in older adults in stressful hospital environments, but warrants clinical context — is this the patient's baseline? Are there acute contributing factors?

Can AMTS be used in patients with low education?

The historical question (WWI year) and current events items can be influenced by educational background and cultural exposure. In patients with very low formal education, adapt the historical question to a major event the patient is likely to know. Document any modifications. For patients with very limited education, other screening tools with less education-dependent items may be more appropriate.

The AMTS-4 is a 4-item abbreviated version of the AMTS used in the 4AT delirium screening tool. It asks 4 of the 10 original questions: age, date of birth, place, and current year. The AMTS-4 is scored 0 (no mistakes), 1 (one mistake), or 2 (two or more mistakes or untestable) for use as the AMT4 component of the 4AT delirium score.

How long does the AMTS-10 take to administer?

The AMTS-10 typically takes 3 to 5 minutes to complete verbally. It requires no paper forms, scoring sheets, or special equipment for bedside administration. This brief administration time makes it practical for routine use in busy acute, emergency, and community clinical settings.

What are the main limitations of the AMTS-10?

Main limitations: (1) cultural and educational effects on the historical events question; (2) focuses on orientation and remote memory without assessing executive function, language, or visuospatial domains affected in non-Alzheimer's dementias; (3) cannot distinguish delirium from dementia without additional assessment; (4) low specificity at the below-8 threshold — many factors can reduce AMTS without true cognitive impairment; (5) requires accurate knowledge of current time, year, and local context for administration.

Online Medical Tools — AMTS-10

Printed on 9/3/2026

For informational purposes only. This is not medical advice.

Geriatrics

AMTS-10

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).

AMTS total score

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How It Works

Administer the 10 Standard AMTS Questions

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 Response as 1 (Correct) or 0 (Incorrect)

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).

Apply Clinical Score Bands to Guide Decision-Making

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.

Who Uses the AMTS-10

Hospital Admission Cognitive Triage for Older Adults

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 Department Cognitive Assessment in Older Patients

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.

Perioperative Cognitive Assessment

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.

Acute Confusion and Delirium Monitoring on Medical and Surgical Wards

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.

Cognitive Assessment in Care Homes and Community Geriatrics

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.

Pro Tips

Adapt the Historical Question to the Local Context

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.

Address Recall Is a Delayed Memory Test

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.

Time Orientation Has a 1-Hour Tolerance

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.

Counting Backward From 20 Allows One Error

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.

Serial AMTS Change Is More Informative Than Single Score

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.

AMTS Is Sensitive to Delirium, But Not Specific

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.

Person Recognition Question Tests Semantic Memory

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.

AMTS Below 7 Is More Specific Than Below 8 for Cognitive Impairment

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.

Use AMTS as Part of an Assessment Battery, Not in Isolation

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.

Common Questions About Your Results

An AMTS of 6 indicates moderate cognitive impairment and warrants further evaluation, but does not diagnose dementia by itself. Important considerations: (1) Is the patient acutely unwell? Delirium, metabolic disturbances, and sedating medications can produce AMTS scores of 5 to 7 in previously cognitively normal patients. (2) Is this score at or near the patient's baseline? If AMTS 6 is the patient's established chronic baseline consistent with known dementia, it does not indicate new acute change. (3) If the patient is medically stable and AMTS 6 represents their true cognitive function, comprehensive dementia workup (cognitive testing, brain imaging, lab evaluation) is indicated. Always interpret AMTS in the context of acute illness status and known baseline.

Score year as 1 (correct) and month as 0 (incorrect), contributing a total of 1 for these two items. Knowing the year but not the month is a common pattern in mild cognitive impairment and early dementia — month orientation is typically lost before year orientation. The reverse pattern (knowing the month but not the year) would be atypical and might suggest a different type of cognitive error. Document the specific items scored incorrectly alongside the total AMTS score for clinical communication.

For patients with significant hearing impairment, AMTS items can be presented in written form on cards or a whiteboard, and the patient can write or point to their answers where possible. Document the modified administration method. Some items (counting backward) can be scored via written response. The adapted format preserves the cognitive content of the test while accommodating the sensory limitation. Note that lip-reading fatigue and cognitive load of communication may affect scores, so interpret with appropriate caution.

The original WWI question was designed for a population with universal primary school education about WWI dates. For patients whose educational background may not include this information, adapt the historical question to a major internationally recognized event with a specific well-known year. For example: 'What year did the first moon landing happen?' (1969) or 'What year did World War II end?' (1945). Alternatively, many UK clinical adaptations also accept 'When did WWII end?' or other historically significant dates. Document any adaptation used.

An acute AMTS drop of 5 points overnight is a major clinical red flag for delirium, which is a medical emergency. Immediately initiate delirium workup: vital signs, oxygen saturation, urinalysis and culture, CBC, BMP, medication review (new medications, interactions, over-sedation), review for missed doses or recent procedures. Administer the [4AT delirium screen](/tools/4at-delirium) to formally characterize delirium features. Implement non-pharmacological delirium management (reorientation, mobilization, sleep hygiene, sensory provision). Notify the attending physician immediately. Document the AMTS scores with timestamps for medical record and legal purposes.

Evidence-Based Methodology

AMTS has been used for decades as a practical 10-item cognitive screen, with broad adaptation across healthcare settings.

Clinical Content Trust

Last reviewed:: April 21, 2026
Guideline version:: General evidence framework v2026.04
Source set version:: Primary-source set v1

How to Interpret Your Result

Lower AMTS scores indicate greater cognitive impairment signal and support follow-up diagnostic evaluation.

When to Use This Tool

Use as a rapid bedside cognitive triage screen when short administration time is required.

Limitations

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.

Sources

Changelog

April 21, 2026 · trust-baseline
Clinical trust metadata enabled for this tool page with structured review/version fields.

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Frequently Asked Questions

The 10 standard AMTS questions are: (1) patient's age, (2) time to nearest hour, (3) address to memorize and recall at end (e.g., 42 West Street), (4) current year, (5) name of the place, (6) recognize two people, (7) date of birth (day and month), (8) year World War I began, (9) name of current monarch/president, (10) count backward from 20 to 1. Questions vary slightly in different published versions.

Both the AMTS and MMSE are brief cognitive screens, but they differ in scope and length. The MMSE has 30 items covering orientation, registration, attention, recall, language, and visuospatial tasks and takes 10 to 15 minutes. The AMTS has 10 items focusing on orientation, remote memory, and recall and takes 3 to 5 minutes. MMSE provides more detailed domain coverage; AMTS is faster for bedside triage. Both have similar sensitivity for detecting moderate-to-severe dementia.

Online Medical Tools — AMTS-10

AMTS-10

How It Works

Administer the 10 Standard AMTS Questions

Score Each Response as 1 (Correct) or 0 (Incorrect)

Apply Clinical Score Bands to Guide Decision-Making

Who Uses the AMTS-10

Hospital Admission Cognitive Triage for Older Adults

Emergency Department Cognitive Assessment in Older Patients

Perioperative Cognitive Assessment

Acute Confusion and Delirium Monitoring on Medical and Surgical Wards

Cognitive Assessment in Care Homes and Community Geriatrics

Pro Tips

Adapt the Historical Question to the Local Context

Address Recall Is a Delayed Memory Test

Time Orientation Has a 1-Hour Tolerance

Counting Backward From 20 Allows One Error

Serial AMTS Change Is More Informative Than Single Score

AMTS Is Sensitive to Delirium, But Not Specific

Person Recognition Question Tests Semantic Memory

AMTS Below 7 Is More Specific Than Below 8 for Cognitive Impairment

Use AMTS as Part of an Assessment Battery, Not in Isolation

Common Questions About Your Results

Evidence-Based Methodology

Clinical Content Trust

How to Interpret Your Result

When to Use This Tool

Limitations

Sources

Changelog

Related Tools

6CIT

SBT

MoCA Score

SLUMS Score

Further Reading

A Comprehensive Guide to Geriatric Medicine: Assessment Tools and Aging Health

Frequently Asked Questions