Delirium is missed in about half of older inpatients because nobody looks. The 4AT is quick, needs no training beyond a few minutes, and works even when the patient cannot complete formal testing.
It has four items: alertness (observed), the AMT4 (age, date of birth, place, year), months of the year backwards, and acute change or fluctuating course. A score of 4 or more suggests delirium; 1 to 3 suggests possible cognitive impairment. Do it on admission, after surgery and whenever behaviour changes.
- Alertness: observe whether the patient is drowsy or agitated
- AMT4: age, date of birth, place, current year
- Months backwards: from December
- Acute change or fluctuation: ask family or nursing staff
- A score of 4 or more suggests delirium; look for the cause
Why it matters
Delirium that is not looked for is not treated.
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