Confusion: AMTS and MMSE (Mini Mental State Exam)
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AMTS – Abbreviated Mental Test Score

AMTS is a (very) quick way to assess confusion. It is used as a quick screening tool, usually on the hospital ward. Patient is scored out of ten, with (variations of) the following questions:
  1. How old are you?
  2. What time is it? (to the nearest hour)
  3. What Year is it?
  4. Where are we?
  5. I want you to remember this address: 42 West Register Street. Ask to recall later on in test.
  6. Do you know who I am? Do you know who that is [point to nurse / family member]?
  7. Do you know who the Prime Minister / President is?
  8. What is your date of birth?
  9. Can you tell me when the second world war ended / the first moon landing was / other memorable date
  10. Can you count down from 20 to 1?
Each question is worth 1 point. A score of <6 is significant for dementia or delirium.

MMSE – Mini-Mental State Examination

Despite its name, this test is not in any way related to the Mental State Examination of psychiatry. It often comes up in OSCE’s, so it’s worthwhile taking time to familiarise yourself with the test.
The test is marked out of 30. It is used to assess cognitive impairment – most commonly as a screening tool for dementia, especially Alzheimer’s. It can also be used to asses a patient’s progress through a phase of cognitive impairment, for example to assess the progression of Alzheimer’s disease. A typical patient, without treatment, will have a declining score of about 3-4 points / year.
An example OSCE station might be “This 45 year old woman is worried about dementia. She thinks she is sometimes forgetful, and her mother has just been diagnosed with Alzheimer’s disease. Please asses her cognitive abilities”

The Test

Questions are divided into sections:
  • Orientation to time
  • Orientation to Place
  • Registration
  • Attention and Calculation
  • Recall
  • Language
  • Repetition
  • Following complex commands


  • ≥25 – Normal
  • 21 – 24 – mild impairment
  • 10 – 20 – moderate impairment
  • <10 – severe impairment
Moderate to severe scores correlate closely to the level of dementia.

Note that cultural and educational factors can contribute to a low score in some instances. Also be wary in patients with physical problems that limit their ability to understand or carry out tasks (e.g. deafness)

The MMSE is copyrighted, and thus unfortunately, we are not able to provide it for you here. This has been a contentious issue, as the test was widely used freely for many years before the copyright holder began to exert their rights and charge for the test’s use. Thus the test became wdiespread as a free test, but now service providers must pay around £0.80 for each and every use. It is likely that a free alternative to the test will be developed in the coming years. You can read more about this in the BMJ.


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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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