Delirium is a very common medical problem in elderly patients admitted to hospital. The 4 key features that characterize delirium include: (1) disturbance of consciousness with reduced ability to focus, sustain, or shift attention; (2) a change in cognition or the development of a perceptual disturbance that is not better accounted for by a pre-existing, established, or evolving dementia; (3) the disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day; and (4) there is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by a medical condition, substance intoxication, or medication side effect.
The Confusion Assessment Method (CAM) is a simple tool that can be used by clinicians to integrate their observations and identify when delirium is the most probable diagnosis. In medical and surgical settings, the CAM has a sensitivity of 94-100% and a specificity of 90-95%.
Confusion assessment method (CAM) for the diagnosis of delirium
The Confusion Assessment Method (CAM) is a simple tool that can be used by clinicians to integrate their observations and identify when delirium is the most probable diagnosis. In medical and surgical settings, the CAM has a sensitivity of 94-100% and a specificity of 90-95%.
Confusion assessment method (CAM) for the diagnosis of delirium
1. Acute onset and fluctuating course
- Usually obtained from a family member or nurse and shown by positive responses to the following questions: "Is there evidence of an acute change in mental status from the patient's baseline?"; "Did the abnormal behaviour fluctuate during the day, that is, tend to come and go, or increase and decrease in severity?"
2. Inattention
- Shown by a positive response to the following: "Did the patient have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was being said?"
3. Disorganized thinking
- Shown by a positive response to the following: "Was the patient's thinking disorganized or incoherent, such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?"
4. Altered level of consciousness
- Shown by any answer other than "alert" to the following: "Overall, how would you rate this patient's level of consciousness?"
Normal = alert
Hyperalert = vigilant
Drowsy, easily aroused = lethargic
Difficult to arouse = stupor
Unarousable = coma
The diagnosis of delirium requires the presence of features 1 AND 2 plus either 3 OR 4.
- Usually obtained from a family member or nurse and shown by positive responses to the following questions: "Is there evidence of an acute change in mental status from the patient's baseline?"; "Did the abnormal behaviour fluctuate during the day, that is, tend to come and go, or increase and decrease in severity?"
2. Inattention
- Shown by a positive response to the following: "Did the patient have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was being said?"
3. Disorganized thinking
- Shown by a positive response to the following: "Was the patient's thinking disorganized or incoherent, such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?"
4. Altered level of consciousness
- Shown by any answer other than "alert" to the following: "Overall, how would you rate this patient's level of consciousness?"
Normal = alert
Hyperalert = vigilant
Drowsy, easily aroused = lethargic
Difficult to arouse = stupor
Unarousable = coma
The diagnosis of delirium requires the presence of features 1 AND 2 plus either 3 OR 4.
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