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The 4AT Manual

The complete practical guide to delirium assessment — free digital editions.

Cover of The 4AT Manual

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.

First editionManual version 1.02026

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Also available as Kindle, paperback and hardback on Amazon.

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Amazon editions

The 4AT Manual is available on Amazon as a Kindle ebook, a paperback and a hardback. The content is identical to the free edition on this page.

Kindle

For the Kindle app. Your notes and highlights stay with your other books.

Kindle on Amazon UK

Paperback

6 × 9 in, black-and-white interior on white paper.

Paperback on Amazon UK

Hardback

Same interior, case-bound.

Hardback on Amazon UK

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The full manual on this page stays free, as a PDF and an EPUB, with no registration. Nothing in the Amazon editions is missing here.

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.

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.