4at validation studies

Gagné AJ, Voyer P, Boucher V, Nadeau A, Carmichael PH, Pelletier M, Gouin E, Berthelot S, Daoust R, Wilchesky M, Richard H, Pelletier I, Ballard S, Laguë A, Émond M. Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department. CJEM. 2018 May 17:1-8. [Epub ahead of print]

O'Sullivan D, Brady N, Manning E, O'Shea E, O'Grady S, O 'Regan N, Timmons S. Validation of the 6-Item Cognitive Impairment Test and the 4AT test for combined delirium and dementia screening in older Emergency Department attendees. Age Ageing. 2018; 47:61-68

Baird L, Spiller JA. A quality improvement approach to cognitive assessment on hospice admission: could we use the 4AT or Short CAM? BMJ Open Qual. 2017; 6(2):e000153

Infante MT, Pardini M, Balestrino M, Finocchi C, Malfatto L, Bellelli G, Mancardi GL, Gandolfo C, Serrati C. Delirium in the acute phase after stroke: comparison between methods of detection. Neurol Sci. 2017; 386:1101-1104

De J, Wand AP, Smerdely PI, Hunt GE. Validating the 4A's test in screening for delirium in a culturally diverse geriatric inpatient population. Int J Geriatr Psychiatry. 2017; 32:1322-1329

Hendry K, Quinn TJ, Evans J, Scortichini V, Miller H, Burns J, Cunnington A, Stott DJ. Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study. Age Ageing. 2016; 45:832-837 

Kuladee S, Prachason T. Development and validation of the Thai version of the 4 'A's Test for delirium screening in hospitalized elderly patients with acute medical illnesses. Neuropsychiatr Dis Treat. 2016; 12:437-43

Bellelli G, Morandi A, Davis DH, Mazzola P, Turco R, Gentile S, Ryan T, Cash H, Guerini F, Torpilliesi T, Del Santo F, Trabucchi M, Annoni G, MacLullich AM. Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing. 2014; 43:496-502

Lees R, Corbet S, Johnston C, Moffitt E, Shaw G, Quinn TJ. Test accuracy of short screening tests for diagnosis of delirium or cognitive impairment in an acute stroke unit setting. Stroke. 2013; 44:3078-83


SELECTED studies using the 4AT

Morandi A, Di Santo SG, Cherubini A, Mossello E, Meagher D, Mazzone A, Bianchetti A, Ferrara N, Ferrari A, Musicco M, Trabucchi M, Bellelli G; ISGoD Group. Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients: Results of a Multicenter Study. Am J Geriatr Psychiatry. 2017; 25:1064-1071.

Bellelli G, Morandi A, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bo M, Bianchetti A, Rozzini R, Zanetti E, Musicco M, Ferrari A, Ferrara N, Trabucchi M; Italian Study Group on Delirium (ISGoD). "Delirium Day": a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. BMC Med. 2016; 14:106

Morandi A, Han JH, Meagher D, Vasilevskis E, Cerejeira J, Hasemann W, MacLullich AM, Annoni G, Trabucchi M, Bellelli G. Detecting Delirium Superimposed on Dementia: Evaluation of the Diagnostic Performance of the Richmond Agitation and Sedation Scale. J Am Med Dir Assoc. 2016; 17:828-33

Bo M, Bonetto M, Bottignole G, Porrino P, Coppo E, Tibaldi M, Ceci G, Raspo S, Cappa G, Bellelli G. Length of Stay in the Emergency Department and Occurrence of Delirium in Older Medical Patients. J Am Geriatr Soc. 2016; 64:1114-9


selected papers relevant to the 4AT



Oliver D. Delirium matters. BMJ. 2016;353:i2886 

De J, Wand AP. Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients. Gerontologist. 2015; 55:1079-99

Shenkin SD, Russ TC, Ryan TM, MacLullich AM. Screening for dementia and other causes of cognitive impairment in general hospital in-patients. Age Ageing. 2014; 43:166-8

Jackson TA, Naqvi SH, Sheehan B. Screening for dementia in general hospital inpatients: a systematic review and meta-analysis of available instruments. Age Ageing. 2013; 42:689-95


Level of alertness/arousal component

Richardson SJ, Davis DHJ, Bellelli G, Hasemann W, Meagher D, Kreisel SH, MacLullich AMJ, Cerejeira J, Morandi A. Detecting delirium superimposed on dementia: diagnostic accuracy of a simple combined arousal and attention testing procedure. Int Psychogeriatr. 2017; 29:1585-1593

Han JH, Brummel NE, Chandrasekhar R, Wilson JE, Liu X, Vasilevskis EE, Girard TD, Carlo ME, Dittus RS, Schnelle JF, Ely EW. Exploring Delirium's Heterogeneity: Association Between Arousal Subtypes at Initial Presentation and 6-Month Mortality in Older Emergency Department Patients. Am J Geriatr Psychiatry. 2017; 25:233-242

Rudolph JL. Arousal, Attention, and an Abundance of Opportunity to Advance Delirium Care. J Am Med Dir Assoc. 2016; 17:775-6

Bellelli G, Mazzone A, Morandi A, Latronico N, Perego S, Zazzetta S, Mazzola P, Annoni G. The Effect of an Impaired Arousal on Short- and Long-Term Mortality of Elderly Patients Admitted to an Acute Geriatric Unit. J Am Med Dir Assoc. 2016; 17:214-9

Han JH, Vasilevskis EE, Shintani A, Graves AJ, Schnelle JF, Dittus RS, Powers JS, Wilson A, Storrow AB, Ely EW. Impaired arousal at initial presentation predicts 6-month mortality: An analysis of 1084 acutely ill older patients. J Hosp Med. 2014; 9:772-8

Tieges Z, McGrath A, Hall RJ, MacLullich AM. Abnormal level of arousal as a predictor of delirium and inattention: an exploratory study. Am J Geriatr Psychiatry. 2013; 21:1244-53

Chester JG, Beth Harrington M, Rudolph JL; VA Delirium Working Group. Serial administration of a modified Richmond Agitation and Sedation Scale for delirium screening. J Hosp Med. 2012; 7:450-3


AMT4 component

Hendry K, Quinn TJ, Evans J, Scortichini V, Miller H, Burns J, Cunnington A, Stott DJ. Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study. Age Ageing. 2016 Aug 8. [Epub ahead of print] 

Schofield I, Stott DJ, Tolson D, McFadyen A, Monaghan J, Nelson D. Screening for cognitive impairment in older people attending accident and emergency using the 4-item Abbreviated Mental Test. Eur J Emerg Med. 2010; 17:340-2

Swain DG, Nightingale PG. Evaluation of a shortened version of the Abbreviated Mental Test in a series of elderly patients. Clin Rehabil. 1997; 11:243-8


Months Backwards component

O'Regan NA, Maughan K, Liddy N, Fitzgerald J, Adamis D, Molloy DW, Meagher D, Timmons S. Five short screening tests in the detection of prevalent delirium: diagnostic accuracy and performance in different neurocognitive subgroups. Int J Geriatr Psychiatry. 2016 Dec 5. [Epub ahead of print]

Hendry K, Quinn TJ, Evans J, Scortichini V, Miller H, Burns J, Cunnington A, Stott DJ. Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study. Age Ageing. 2016; 45:832-837

Meagher J, Leonard M, Donoghue L, O'Regan N, Timmons S, Exton C, Cullen W, Dunne C, Adamis D, Maclullich A, Meagher D. Months backward test: A review of its use in clinical studies. World J Psychiatry. 2015; 5:305-14

O'Regan NA, Ryan DJ, Boland E, Connolly W, McGlade C, Leonard M, Clare J, Eustace JA, Meagher D, Timmons S. Attention! A good bedside test for delirium? J Neurol Neurosurg Psychiatry. 2014; 85:1122-31