Table 1.
DSM-5 structured reference standard for delirium
| 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 | 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. |
DSM-5 Diagnostic Statistical Manual-5, AMT10 Abbreviated Mental Test 10, OMCT Short Orientation, Memory and Concentration Task, OSLA Observational Scale of Level of Arousal, RASS Richmond Agitation-Sedation Scale