Table 1 DSM-5 structured reference standard for delirium

A. Disturbance in attention and awareness

• Months of the year backward

• Days of the week backwards

• Counting from 20 to 1

• Digit span forward (3, 4 and 5 digits)

• Vigilance A

Inattention if errors on ≥2 of the tests above.

• RASS (score ≠ 0)

• OSLA (score > 2)

Any behavioural signs that suggest inattention, lack of awareness and orientation, distractibility, verbal perseverations, etc.

Evidence of inattention from an informant (clinical staff, medical notes, relatives) within the last hour.

B. Acute change from baseline cognitive status (usually hours to a few days) and/or fluctuation in symptom severity

N/A

N/A

N/A

Evidence of acute onset and/or fluctuation in symptom severity from medical notes, clinical staff or relatives. Has there been a sudden change in mental state, diurnal variation or altered level of consciousness during the day?

C. Additional disturbance in cognition

MEMORY

• Recall of 3 words (lemon, key, ball)

• Recall of address (AMT10)

• Recollection of World War 2 start and end date (AMT10)

• Name of current prime minister (AMT10)

Memory impairment if error on any of the tests above.

ORIENTATION (from OMCT)

• Time

• Person

• Place

Disorientation present if error on ≥2 items.

N/A

LANGUAGE

Assess fluency, grammar, comprehension and semantic content during communication.

PERCEPTUAL DISTURBANCE

Self-report of hallucination and/or delusions

VISUOSPATIAL

Ask patient which of any two objects is closer to them; Ask the patient if the room looks tilted;

Consider placement of initials and signature on consent form.

Any evidence of cognitive disturbance that is obtained from medical notes or clinical team.

D. Disturbances in criteria A and C are not better explained by another disorder and do not occur in the context of coma

N/A

N/A

N/A

Discuss with medical team and/or family and consult medical notes.

E. Evidence that the disturbance is a direct physiologic consequence of another medical condition, substance intoxication or withdrawal, exposure to a toxin or because of multiple etiologies.

N/A

N/A

N/A

Discuss with medical team and/or family and consult medical notes.