assessment and workup for delirium

Last edited 06/2018

assessment & work up of delirium patients

The most important step in diagnosing delirium is to obtain a history from a person who is taking care of the patient (e.g.- family member, caregiver etc) and carrying out a brief cognitive assessment (1)

  • accurate history is necessary to
    • to establish patients baseline cognitive functions and to identify any recent (within past 2 weeks) changes in mental status
    • identify fluctuations in cognition and other symptoms typical of delirium
    • look for a cause
      • recent changes in disorder, new diagnoses
      • review all current drugs (including over-the-counter and herbal preparations); pay special attention to new drugs and drug interactions
      • review alcohol and sedative use
      • assess for pain and discomfort (eg, urinary retention, constipation, thirst)
  • cognitive screening test should be carried out
    • e.g. - portable mental status questionnaire, the mini-cog, or the Montreal cognitive assessment
    • if time constraints, can use the following assessment of orientation and an attention tasks in place of the basic screening
      • naming of days of the week (no errors should be allowed) or months of the year (one error should be allowed) backwards
      • serial sevens (one error should be allowed for five subtractions)
      • recitation of digit spans (normally three or more) backwards (1)

Physical and neurological examination

  • check for vital signs - temperature, oxygen saturation, fingerstick glucose concentration
  • search for signs of occult infection, dehydration, acute abdominal pain, deep vein thrombosis, other acute illness;
  • assess for sensory impairments
  • search for focal neurological changes and meningeal signs (1)

Further assessment should be carried out according to the clues obtained from history and physical examination and previous results e.g. -

  • targeted laboratory examinations and neuroimaging
  • EEG

Reference: