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Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly


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)

Copyright : free to use  (

Translations : available in several languages access





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


  • ​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

Back To : Delirium

confused old woman in bed

Delirium is one of 4 sub-domains of the  

Psychological Assessment

Back To : Psychological Assessment

pensive elderly old man_edited_edited.png

The Psychological Assessment is one of 8 domains of the

Comprehensive Geriatric Assessment (CGA)

Back To : Comprehensive Geriatric Assessment

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