Assessment scales for delirium: A review

Table 1 Scales for assessment of delirium in clinical and research setting

Instruments for assessment of arousability of the patient	RASS[9]
Instruments for screening for premorbid cognitive disturbances	IQCODE[10,11]
Screening instruments	NEECHAM Confusion Scale[12]
	Nursing Delirium Screening Scale[13]
	Delirium Observation Screening Scale/Delirium Observation Scale[14,15]
	Intensive care delirium screening checklist[16]
	Pediatric Anesthesia Emergence Delirium scale[17]
	Global Attentiveness Rating[18]
Diagnostic instruments	Delirium Symptom Interview[19]
	Saskatoon Delirium Checklist[20]
	Delirium Rating Scale-revised version[21]
	Memorial Delirium Assessment Scale[22]
	Confusion Assessment Method[23]
	CAM-ICU[24,25]
	Paediatrics CAM-ICU[26]
	Clinical Assessment of Confusion - A and B[27,28]
Instruments for Assessment of severity of delirium	Delirium Rating Scale[29]
	Delirium Rating Scale-Revised-98[21]
	Confusion Assessment Method[23]
	Confusion Assessment Method for Intensive Care Unit assessment tool[24,25]
	Delirium-O-Meter[30]
	Delirium Index[31]
	Memorial Delirium Assessment Scale[22]
	Confusional State Evaluation Scale[32]
	Delirium Assessment Scale[33]
	Delirium Severity Scale[34]
Instruments for assessment of cognitive symptoms only	Mini Mental Status Examination[35]
	Cognitive Test for Delirium[36,37]
	Clock Drawing test[38]
	Digit Span Test[39,40]
	Vigilance “A” Test[40]
	Mental state Questionnaire[41,42]
	Short Portable Mental Status Questionnaire[43]
Motor symptoms	Delirium Motor Checklist, Delirium Motor Symptom Scale[44,45]
	Richmond Agitation and Sedation Scale[9]
	Motoric items of Delirium Rating Scale, Delirium Rating Scale-Revised-98, Memorial Delirium Assessment Scale[21,22,29]
Etiology, risk factors	Delirium Etiology Checklist[46]
Paediatric delirium	Pediatric Anesthesia Emergence Delirium scale[17]
Distress with delirium experience	Delirium Experience Questionnaire[47]

CAM-ICU: Confusion Assessment Method for Intensive Care Unit assessment tool.

Table 2 Important features of rating scales useful for screening, diagnosis and severity rating of Delirium

Scale	Criteria on which the scale was based	No. of items	Ratings done by	Time taken in minutes	Screening	Diagnosis	Severity rating
Clinical Assessment Confusion-A[27,28]		25	Nurses	< 5		√
Clinical Assessment Confusion-B[27,28]		58	Nurses			√
Confusion Assessment Method[23]	DSM-III-R	9	Non psychiatrist clinicians	< 5	√	√	√
Confusion State Evaluation[32]	Research	22	Nurses, physicians, psychologists	< 30		√	√
Cognitive Test for Delirium[36,37]	DSM-III-R	9	Research assistant	10-15
Delirium Assessment Scale[33]	DSM-III	8	Physicians				√
Delirium Index[31]	DSM-III-R	7	Research assistant	5-10			√
Delirium Observation Screening Scale[14,15]	DSM-IV	25	Research assistant	5-10	√
Delirium Observation Scale[14,15]	DSM-IV	13	Nurses	< 5	√
Delirium Rating Scale[29]	DSM-III	10	Trained clinicians				√
Delirium Symptom Interview[19]	DSM-III	109	Trained interviewer	15		√	√
Delirium Severity Scale[34]			Research assistant	10			√
Memorial Delirium Assessment Scale[22]	DSM-IV	10	Physicians	10-15			√
NEECHAM Confusion Scale[12]	Research	9	Nurses	10	√
Delirium Rating Scale-Revised-98[21]	DSM-IV	16	Psychiatrists
Nursing Delirium Screening Scale[13]		5	Nurses	1	√	√
Intensive care delirium screening checklist[16]	DSM-IV	8	Non-specialist staff	7-10
Pediatric Anesthesia Emergence Delirium scale[17]		5
Saskatoon Delirium Checklist[20]	DSM-III	10	Clinician	< 15		√
Delirium-O-Meter[30]	DSM-IV	12	Limited training				√
Confusion assessment method for intensive care unit assessment tool[24,25]	DSM-IV	9	Trained health professional	< 5		√

DSM: Diagnostic and Statistical Manual.

Table 3 Symptom coverage by various scales vis a vis Diagnostic and Statistical Manual-III, IIIR, IV and International Classification of Diseases, Tenth Revision criteria

Diagnostic criteria/rating scale	Acute onset	Fluctuating course	Presence of Physical Disorder	Disturbance in level of Consciousness	Disturbance in Attention	Disturbance in orientation	Disturbance in Thinking	Memory disturbances	Perceptual abnormality	Disturbance in psychomotor activity	Alterationin sleepwake cycle	Moodfeatures	Others
DSM-III[6]	√	√	√	√	√	√	√	√	√	√	√
DSM-IIIR[7]	√	√		√	√	√	√	√	√	√	√
DSM-IV[8]	√	√	√	√	√	√	√	√	√
ICD-10[54]	√	√	√	√	√	√	√	√	√	√	√	√
CAC-A[27,28]						√		√	√	√			√6
CAC-B[27,28]						√		√	√	√			√6
CAM[23]	√	√	√	√	√	√	√	√	√	√	√
CSE[32]	√	√			√	√	√	√	√	√	√	√	√1
CTD[36,37]					√	√		√
DAS[33]		√			√	√	√	√		√
Delirium-O-meter[30]		√		√	√	√	√3		√	√		√4
DI[31]				√	√	√	√	√	√	√
DOS[14,15]					√	√	√	√	√	√	√	√	√7
DRS[29]	√	√	√			√	√	√	√	√	√	√
DRS-R-98[21]	√	√	√	√	√	√	√	√	√	√	√	√	√2
DSI[19]		√		√	√	√	√	√	√	√	√
DSS[34]					√		√	√
ICDSC[16]		√		√	√	√	√2		√	√	√	√2
MDAS[22]				√	√	√	√	√		√
NEECHAM[12]					√	√	√	√
Nu-DESC[13]						√			√	√			√5
Saskatoon DC[20]		√	√	√		√		√	√	√	√		√2

¹Includes perseveration, impaired contact, irritability, mental uneasiness, intensity of the current episode, frequency and intensity of the episodes;

²Inappropriate thinking or mood;

³Incoherence of speech;

⁴Includes apathy and anxiety;

⁵Inappropriate behaviour, inappropriate communication;

⁶General behaviour;

⁷Is picking, disorderly, restless; Pulls IV tubing, feeding tubes, catheters, etc. DSM: Diagnostic and Statistical Manual; ICD-10: International Classification of Diseases, Tenth Revision; DRS-R-98: Delirium Rating Scale-revised version; CTD: Cognitive Test for Delirium.