4AT : Delirium - Geriatric Primary Care

Resources for the Comprehensive Geriatric Assessment based

Proactive and Personalised Primary Care of the Elderly

4AT

4 A's Test

Purpose : Rapid assessment test for delirium

Admin time : 3 min.

User Friendly : High

Administered by : GP or nurse

Content : The 4AT has 4 items, each of which begins with an ‘A’:

[1] Alertness

[2] AMT4: Abbreviated Mental Test - 4.

[3] Attention test: Months of the Year Backwards

[4] Acute change or fluctuating course

Author : Prof Alasdair MacLullich (Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland), and Dr Tracy Ryan and Dr Helen Cash (NHS Lothian, Scotland), 2011

Revised 2014 (version 1.2)

Translations : available in several languages access

4AT

Advantages:

The 4AT was designed specifically for routine clinical use. It has features that mean that it can readily be implemented in day to day practice:

short
simple
no special training needed
built-in cognitive testing
gives a clinically informative 4AT score, not an Unable To Assess (UTA), in patients too sleepy or restless for cognitive testing or interview
good sensitivity and specificity
effective in practice: detects delirium at the expected level
no registration or permissions needed

Disadvantages:

Patients suffering from dementia or confusion may react to the test with strong emotional reactions, such as irritation, frustration, anxiety, and anger.

Accuracy :

sensitivity 88% and specificity 88% (Tiegers Z, 2021)

This Tool is used in Delirium

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