4AT - Assessment of Delirium

Question 1

What is the first criteria in the 4AT assessment and what scores can the patient be assigned?

Answer 1

Altertness:
Normal (and not agitated) = 0
Mild sleepiness for <10 seconds on waking = 0
Clearly abnormal = 4

Question 2

What is the second criteria in the 4AT assessment and what questions can the patient be asked to assess this?

Answer 2

AMT4:

• Age
• Date of birth
• Place
• Current year

Question 3

What scores can the patient be assigned under the second criterion of 4AT?

Answer 3

No mistakes = 0
One mistake = 1
Two or more mistakes = 2

Question 4

What is the third criteria in the 4AT assessment and what question can the patient be asked to assess this?

Answer 4

Attention:

• “Please tell me the months of the year backwards starting with December”
• Can be assisted by prompt “what is the month before December?”

Question 5

What scores can the patient be assigned under the third criterion of 4AT?

Answer 5

Achieves 7 or more months correctly = 0
Starts but scores less than 7/refuses = 1
Untestable (unwell, drowsy, inattentive) = 2

Question 6

What is the fourth criteria in the 4AT assessment and what scores can the patient be assigned?

Answer 6

Acute change or fluctuating course:

• No changes = 0
• Changes in alertness, cognition, other (paranoia, hallucinations) arising over last 2 weeks and still present in previous 24 hours = 4

Question 7

What 4AT scores indicate what mental states?

Answer 7

0 = Delirium unlikely (If 4 untavailable still possible)
1-3 = Possible cognitive impairment
4 or more = Possible delirium +/- cognitive impairment