Cognitive assessment in the ED: Abbreviated Mental Test (AMT/AMTS) and MMSE
Assessment of cognition is essential for any patient with altered behaviour, confusion, a reduced Glasgow Coma Scale relative to baseline, suspected delirium or possible dementia. In the ED the immediate priorities are rapid identification of delirium or acute cognitive change and detection of baseline cognitive impairment so that reversible causes can be investigated and disposition and communication decisions can be made promptly (NICE CG103; RCEM).
This section summarises the roles, practical use and limitations of the Abbreviated Mental Test (AMT/AMTS) and the Mini‑Mental State Examination (MMSE), sets out ED‑focused recommendations from guideline sources, and gives practical actions for abnormal results.
Why test cognition in the ED
- Rapid cognitive screening helps detect delirium, an acute and often fluctuating disturbance of attention and awareness.
- Screening identifies pre‑existing cognitive impairment that affects management, capacity and disposition.
- Results change immediate care (investigations, need for admission, medication decisions, involvement of liaison teams).
- Results should be documented and communicated to carers and receiving teams (RCEM).
Key guideline points (NICE / RCEM)
- Use a brief validated instrument for delirium screening in acute settings; NICE lists AMT and 4AT as suitable bedside tools while CAM requires trained users (NICE CG103).
- RCEM recommends adopting a single brief validated screen (4AT or AMT) for older patients in the ED...
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