Diagnosis of delirium

Information from other informants can be very helpful, but bedside clinical testing is the mainstay. Tests such as the Mini-Mental State Examination are extremely useful, but the psychiatrist must not be in the position of being unable to proceed if they are unavailable. If there is suspicion of cognitive impairment, cognitive testing should tactfully be introduced near the start of the assessment, lest time be wasted attempting to take an incoherent history from a patient who turns out to have gross cognitive abnormalities when tested at the end of the interview. Formal testing is also useful for monitoring progress.

There are numerous assessment scales, some intended for routine clinical testing by non-specialists. (8) An example of a brief assessment is the Cognitive Test for Delirium.(9) However, only two of the scale's attributes (visual attention span and recognition memory for pictures) were able to distinguish delirium from dementia, schizophrenia, and depression (p < 0.0001) and delirium from moderate to severe dementia (p < 0.0002). This confirms the importance of testing attention and short-term memory in this group. Special investigations (such as electroencephalography (10)) have little role in the diagnosis of delirium itself. Their main role is in identifying the underlying cause of delirium (see above), especially in making sure that treatable causes have been excluded.

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