|DSM-5 criteria||Source of information|
|Cognitive test||Arousal scale||Interview||Informant|
|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||
• 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)
Disorientation present if error on ≥2 items.
Assess fluency, grammar, comprehension and semantic content during communication.
Self-report of hallucination and/or delusions
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.|