4AT Delirium Assessment Tool
Rapid bedside delirium assessment for older adults; no special training needed. Score ≥ 4 suggests possible delirium; 1–3 possible cognitive impairment.
Score interpretation
4AT 0 — delirium is still possible if the acute-change information is incomplete.
→ Continue clinical assessment; monitor; repeat 4AT if deterioration
4AT 1–3.
→ Assess for underlying dementia; formal cognitive testing when acute illness resolved; MMSE or MoCA in follow-up
4AT ≥ 4 — not diagnostic; confirm clinically.
→ Delirium management bundle: treat precipitants (infection, pain, medication), reorientation, hydration, early mobilisation, avoid restraints; avoid benzodiazepines; haloperidol if distressing hyperactive delirium
Interpretation bands for the 4AT Delirium. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Milrinone · Inodilator / Acute Heart Failure
- Prednisolone (Systemic) · Systemic Corticosteroid — Acute Dermatoses
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Colchicine (Acute Gout) · Anti-Inflammatory (Microtubule Inhibitor)
- Falls Assessment in Older Adults · NICE CG161 2013
- Delirium Outside ICU · NICE CG103
- Comprehensive Geriatric Assessment (CGA) · BGS / NICE
- Delirium Assessment and Management · NICE CG103 2010
- Frailty Recognition and Management · BGS Frailty Framework / NHS NHSE
- Polypharmacy and Medicines Optimisation · STOPP/START v2 2014 / NICE NG5
Featured in these MRCEM clinical pathways
The 4AT Delirium is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.