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Table 1 Standardised diagnostic algorithm for DSM-5 delirium

From: Protocol for the Delirium and Cognitive Impact in Dementia (DECIDE) study: A nested prospective longitudinal cohort study

DSM-5 criteria

Test to be performed or information needed

A. Disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).

Observations by the examiner during the interview (initiated by questioning such as “can you tell me what has been going on today?”)

Level of arousal measured using m-RASS and OSLA

Months of the year backwards

Digit span from MDAS

B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.

Acute onset and/or fluctuation obtained from informant history from nursing staff, next of kin and clinical notes

C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).

Impairment in any of the following domains:

SHORT-TERM MEMORY: three item recall at three minutes

LONG-TERM MEMORY: when did World War II end?

ORIENTATION: 10 orientation questions from MDAS

LANGUAGE: 3 stage command, naming an object and explain purpose of object along with fluency, comprehension and content of conversation

VISUOSPATIAL: Will a stone float on water?

PERCEPTUAL DISTURBANCE: evidence of illusions or hallucinations by collateral or direct observation/questioning

D. The disturbances in criteria A and C are not explained by another pre-existing, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.

Information from history/chart/clinical examination

E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiologic consequence of another medical condition, substance intoxication or withdrawal (i.e., because of a drug of abuse or to a medication), or exposure to a toxin or is because of multiple aetiologies.

Information from history/chart/clinical examination

  1. Abbreviations:
  2. m-RASS modified Richmond Agitation and Sedation Scale [37]
  3. OSLA Observational Scale of Level of Arousal [38]
  4. MDAS Memorial Delirium Assessment Scale [23]