Selected literature relevant to the 4AT

General

Rieck KM, Pagali S, Miller DM. Delirium in hospitalized older adults. Hosp Pract. 2020 Mar;48(sup1):3-16

Davis D, Searle SD, Tsui A. The Scottish Intercollegiate Guidelines Network: risk reduction and management of delirium. Age Ageing. 2019;48:485-488

Bearn A, Lea W, Kusznir J. Improving the identification of patients with delirium using the 4AT assessment. Nurs Older People. 2018;30:18-27

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

Level of alertness/arousal component

Tieges Z, Quinn T, MacKenzie L, Davis D, Muniz-Terrera G, MacLullich AMJ, Shenkin SD. Association between components of the delirium syndrome and outcomes in hospitalised adults: a systematic review and meta-analysis. BMC Geriatr. 2021 Mar 5;21(1):162.

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

Grossmann FF, Hasemann W, Kressig RW, Bingisser R, Nickel CH. Performance of the modified Richmond Agitation Sedation Scale in identifying delirium in older ED patients. Am J Emerg Med. 2017;35(9):1324-1326.

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

Morandi A, Han JH, Meagher D, et al. Detecting Delirium Superimposed on Dementia: Evaluation of the Diagnostic Performance of the Richmond Agitation and Sedation Scale. J Am Med Dir Assoc. 2016;17(9):828-833.

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, Schnelle JF, et al. The Diagnostic Performance of the Richmond Agitation Sedation Scale for Detecting Delirium in Older Emergency Department Patients. Acad Emerg Med. 2015;22(7):878-882.

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

Lindsay WA, Moppett IK. Interchangeability of AMT4 and AMTS in a hip fracture population. Anaesthesia. 2019;74(11):1477-1478.

Carpenter CR, Banerjee J, Keyes D, et al. Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta-analysis. Acad Emerg Med. 2019;26(2):226-245.

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(6):832-837.

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

Hasemann W, Duncan N, Clarke C, Nouzova E, Süßenbach LM, Keerie C, Assi V, Weir CJ, Evans J, Walsh T, Wilson E, Quasim T, Middleton D, Weir AJ, Barnett JH, Stott DJ, MacLullich AMJ, Tieges Z. Comparing performance on the Months of the Year Backwards test in hospitalised patients with delirium, dementia, and no cognitive impairment: an exploratory study. Eur Geriatr Med. 2021 Jun 22.

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]

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