4AT

4AT

The 4AT is a rapid clinical test used in medicine for the detection of delirium and cognitive impairment. It was developed by a team of clinicians and researchers led by Dr. Susan D. Shenkin and Professor Alasdair M.J. MacLullich at the University of Edinburgh in the United Kingdom. The 4AT has been validated in a variety of clinical settings and populations, and is used worldwide.

Overview

The 4AT is a brief assessment tool that does not require special training to administer. It consists of four items, hence the name "4AT". The items assess alertness, cognitive impairment, acute change in mental status, and inattention, which are the core features of delirium. The 4AT can be completed in under 2 minutes, making it a practical tool for busy clinical settings.

Components of the 4AT

The 4AT consists of the following four items:

1. Alertness: This is assessed by observing the patient during the assessment. If the patient is not fully alert, they score 4 points.
2. AMT4: This is a brief test of cognitive impairment. The patient is asked to state their age and date of birth, recall the current year, and recall the name of the hospital. Each incorrect answer scores 1 point.
3. Acute change or fluctuating course: This is assessed by asking the patient or a relative or carer about any changes in the patient's mental status over the past 2 weeks. If there has been a change, the patient scores 4 points.
4. Inattention: This is assessed by asking the patient to say the months of the year backwards. If the patient makes one or more errors, they score 2 points.

A score of 4 or more indicates a high risk of delirium.

Use in Clinical Practice

The 4AT is used in a variety of clinical settings, including emergency departments, general medical wards, geriatric wards, and postoperative recovery units. It is also used in research studies investigating delirium and cognitive impairment.

Limitations

While the 4AT is a useful tool for detecting delirium and cognitive impairment, it is not a diagnostic tool. A positive 4AT score should prompt further assessment by a healthcare professional with expertise in delirium and cognitive impairment.

See Also

• Delirium
• Cognitive impairment
• Geriatrics
• Neurology