4AT rapid delirium assessment
Two-minute delirium and cognitive impairment screen.
Inputs
CompleteAlertness
AMT4 (age, date of birth, place, year)
Attention: months of the year backward
Acute change or fluctuating course
Worked calculation
Your values are highlighted.
- Points
When to use
- Older adults on admission or with any change in mental status.
Pearls and pitfalls
- 4 or more: possible delirium; 1–3: possible cognitive impairment.
Why use
No training needed; works in drowsy patients.
| Criterion | Points |
|---|---|
| Alertness: Normal, or mild sleepiness under 10 s after waking | 0 |
| Clearly abnormal | +4 |
| AMT4 (age, date of birth, place, year): No mistakes | 0 |
| 1 mistake | +1 |
| 2 or more mistakes, or untestable | +2 |
| Attention: months of the year backward: 7 or more months correct | 0 |
| Starts but fewer than 7, or refuses | +1 |
| Untestable | +2 |
| Acute change or fluctuating course | +4 |