In a prospective observational audit, consecutive admissions to a single team over a 10-week period, March–May 2013, were admitted using a structured clerking proforma. The Oxford University Hospitals Trust provides services for all acute medicine patients in a population of ∼500,000 and runs an unselected medical admissions system irrespective of age, with the majority of patients remaining under the admitting team. Specifically, we aimed to determine (i) the rates and reasons for untestability using the AMTS, (ii) whether subjective memory complaint agreed with objective cognitive deficit as defined by the AMTS and (iii) whether the AMTS identified objective cognitive deficit detected on the more detailed Montreal Cognitive Assessment (MoCA) and an informant-based test for pre-morbid cognitive function, the informant questionnaire for cognitive decline in the elderly (IQCODE). We therefore determined the feasibility and validity of the AMTS performed at the point of admission to the general hospital in a consecutive cohort of patients aged ≥75 years admitted to acute general (internal) medicine. The abbreviated mental test score (AMTS) is recommended as a brief pragmatic test of cognitive function in the general hospital ( …/concise-delirium-2006.pdf but there are few contemporary data particularly in the hyper-acute setting. A brief quantitative and objective measure of cognitive function, at the point of admission, will provide a baseline record including in those with known dementia, facilitate delirium diagnosis and inform clinical decision-making particularly around early involvement of families and consent processes. Routine cognitive screening for older people admitted to the general hospital is therefore recommended ( …/concise-delirium-2006.pdf but needs to be feasible and pragmatic in view of resource constraints and patient acceptability. However, services in the general hospital have often failed to adapt to the increasing numbers of frail patients with multiple co-morbidities, and cognitive impairment is often not recognised by staff because of a tendency to focus on physical rather than mental health. Dementia (often previously undiagnosed) and delirium are prevalent, and decrements in cognitive function may also occur in acute illness in the absence of overt delirium. Up to one half of the in-patient population of the average general hospital is aged over 65 years and many have co-morbid cognitive impairment associated with high care needs and poor outcomes including increased mortality, complications and institutionalisation. Objective cognitive deficits were prevalent in patients without known dementia or delirium but were not reliably identified by subjective cognitive complaint or informant report.ĪMTS, subjective memory complaint, Montreal Cognitive Assessment, IQCODE, cognitive screening, older people Introduction
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In contrast, correlation between AMTS and MoCA was strong ( R 2 = 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.Ĭonclusions: the AMTS was feasible and valid in older acute medicine patients agreeing well with the MoCA albeit with a ceiling effect. 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). 49/50 (98%) testable patients with dementia/delirium had low AMTS compared with 79/199 (44%) of those without ( P < 0.001). Cognitive impairment was defined as AMTS < 9 or MoCA < 26 (mild impairment) and MoCA < 20 (moderate/severe impairment) or IQCODE ≥ 3.6.
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At ≥72 h, the 30-point Montreal Cognitive Assessment (MoCA) and Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) were done. 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). 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. Introduction: routine cognitive screening for in-patients aged ≥75 years is recommended, but there is uncertainty around how this should be operationalised.