Free official digital edition
A practical guide to delirium assessment
The 4AT Manual gives clinicians clear, practical guidance on using the 4AT well, from preparing for the assessment and scoring each item to interpreting the result and acting on concerns.
Written by Professor Alasdair MacLullich, who developed the 4AT with Tracy Ryan and Helen Cash, it brings together the rationale, evidence, worked clinical examples and lessons from implementation.
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E-reader edition
Best for e-readers, phones and tablets. The text adapts to your screen and you can change the font size. This edition includes the front cover.
EPUB · 465.5 KB
Fixed-page edition
Best for reading in a browser, printing, or using stable page references. The 102-page manual is unchanged, with the front and back covers added as unnumbered pages.
PDF · 1.6 MB · 104 pages including covers
Inside the manual
- Why the 4AT was developed and how it supports delirium assessment
- Step-by-step guidance on administering and scoring each item
- How to interpret the result and decide what should happen next
- Worked cases from a range of clinical settings
- Common difficulties, special situations, implementation and audit
- An overview of the evidence supporting the 4AT
The manual is for nurses, doctors, allied health professionals, students, educators, researchers, and teams implementing delirium pathways or electronic health records.
Related clinical guidance: For more on interpreting the cognitive findings and deciding when further assessment may be needed, see 4AT cognitive assessment and possible dementia.
Coming shortly
Amazon editions
Kindle, paperback and hardback editions will be available on Amazon shortly. Watch this space.
The official digital edition on this page is free and will remain available here.
Important information
The 4AT does not diagnose delirium on its own. A score must be interpreted alongside clinical assessment, collateral history, investigation and local guidance. A person who may have delirium requires prompt clinical assessment.
Copyright and reuse
Copyright © 2026 Alasdair MacLullich. Except where otherwise stated, the text, tables and original diagrams in this manual are licensed under the Creative Commons Attribution 4.0 International licence (CC BY 4.0). The 4AT oval logo, cover artwork and design, and separately credited third-party material are excluded. The licence does not grant trademark rights or permit any implication of endorsement.
Complete, unmodified copies of this edition may include those excluded elements under the publisher’s separate permission set out in the manual; they must not be extracted, adapted or used separately. Please use the publication information inside the manual when citing or reusing it.
For the assessment tool itself, see Attribution and reuse of the 4AT.