Cognitive impairment is common in elderly people and is associated with increased morbidity and mortality,1 but confusion is often poorly recognised and documented by medical staff.2 3 Thus, routine cognitive screening of elderly patients in hospital has been recommended.4

One validated and widely used screening instrument is the abbreviated mental test score, in which the maximum score is 10 and a score below 7 suggests cognitive impairment.5 It is widely used in clinical and research settings in Britain for detecting and monitoring cognitive impairment and is easily administered and well tolerated by raters and subjects. Inconsistencies in giving and scoring the test will affect its reliability, validity, and sensitivity in detecting change. We noticed differences between colleagues in the use and scoring of this test and investigated how it was applied in routine clinical …