Evaluating mental state in adults

Seek information about changes in the patient’s cognition and behaviour from a reliable source—if this is not the patient (eg the patient has dementia), ask their significant other or carer.

Tools to identify adults with acutely altered cognition include the:

  • 4AT test
  • Confusion Assessment Method (CAM)1 and its variants (eg CAM-ICU2, 3D–CAM3); 3D-CAM considers that delirium is likely if the patient has experienced an acute onset of fluctuating symptoms including:
    • inattention, and
    • either disorganised thinking or an altered level of consciousness.

Consider whether another condition could explain the patient’s change in mental state (eg dementia, depression, psychosis).

If delirium is suspected, undertake further assessment.

1 Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990;113(12):941-8. [URL]Return
2 Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2001;29(7):1370-9. [URL]Return
3 Marcantonio ER, Ngo LH, O’Connor M, Jones RN, Crane PK, Metzger ED, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med 2014;161(8):554-61. [URL]Return