palliative psychiatry geriatrics

MDAS — Memorial Delirium Assessment Scale

10-item clinician-rated delirium severity scale (Breitbart 1997); each item 0–3, total 0–30. Diagnostic cut-off 13 in the original study; 7 performed best in advanced cancer (Lawlor 2000). Confirm delirium with DSM-5 criteria.

Q1. Reduced level of consciousness (awareness)*

Q2. Disorientation*

Q3. Short-term memory impairment*

Q4. Impaired digit-span*

Q5. Reduced ability to maintain and shift attention*

Q6. Disorganised thinking*

Q7. Perceptual disturbance*

Q8. Delusions*

Q9. Decreased or increased psychomotor activity*

Q10. Sleep-wake cycle disturbance*

Score interpretation

MDAS < 7 — Below the Delirium Cut-offs 0–6

Below both published cut-offs (7 and 13).

→ Continue baseline care. Repeat MDAS daily in at-risk inpatient (≥75 yr, post-op, ICU, advanced cancer).

MDAS 7–12 — Possible Delirium 7–12

At or above the advanced-cancer cut-off of 7 (Lawlor 2000), below the original cut-off of 13.

→ TIME bundle: Triggers (sepsis, electrolytes, glucose, hypoxia, retention, constipation, drugs); Investigate; Manage; Engage family. Non-pharmacological first-line: orientation, sleep hygiene, glasses/hearing aids, mobilise, limit nocturnal disturbance.

MDAS ≥ 13 — Delirium Likely 13–30

At or above the original cut-off of 13 (Breitbart 1997); higher scores mean more severe delirium.

→ Continue TIME bundle. Adults: cautious low-dose haloperidol 0.5 mg PO/IM (avoid in PD/LBD — use quetiapine 12.5–25 mg); short course only. Children: use a children's formulary. Move to side room with familiar carer if possible. More severe delirium: Senior medical and nursing review. Specialist mental-health-of-older-adults (MHOA) liaison. Address risk to self / staff. Consider quetiapine, midazolam SC in palliative context. End-of-life discussion if dying patient — terminal restlessness common; midazolam SC + levomepromazine for refractory agitation.

Interpretation bands for the MDAS. Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Haloperidol (Delirium) · Typical Antipsychotic (Butyrophenone)

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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