DSM-5 criteria | Test to be performed or information needed |
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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 |