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4-AT

ALERTNESS​

Drowsy (e.g. difficult to rouse and/or obviously sleepy) or agitated/hyperactive. Observe the patient. If asleep, attempt to wake. Ask the patient to state their name and address to assist rating.

  • Normal (fully alert, but not agitated, throughout assessment) - 0
  • Mild sleepiness for <10 seconds after waking, then normal - 0
  • Clearly abnormal - 4

AMT4​

Age, date of birth, place (name of the hospital or building), current year.

  • No mistakes - 0
  • 1 mistake - 1
  • 2 or more mistakes/untestable - 2

ATTENTION​

Months of the year backwards One prompt of “what is the month before December?” is permitted.

  • Achieves 7 months or more correctly - 0
  • Starts but scores <7 months / refuses to start - 1
  • Untestable (cannot start because unwell, drowsy, inattentive) - 2

ACUTE CHANGE OR FLUCTUATING COURSE​

Evidence of significant change or fluctuation arising over the last 2 weeks

  • No - 0
  • Yes - 4

4AT SCORE​

  • 4 or above: possible delirium +/- cognitive impairment
  • 1-3: possible cognitive impairment
  • 0: delirium or severe cognitive impairment unlikely (but delirium still possible if acute change information incomplete)