An observational study to assess the performance of the 4AT tool for measuring recovery from delirium in hospitalised older people

Assessing recovery from delirium in older hospitalised people: optimisation and validation of the 4AT

Status

Active, not recruiting

Phases

Unknown

Study type

Observational

Source

ISRCTN

Registry ID

ISRCTN48221972

Enrollment

150

Registered

2022-02-22

Start date

2021-12-06

Completion date

Unknown

Last updated

2026-03-23

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Assessing delirium in older hospitalised patients - a severe and distressing neuropsychiatric syndrome which is characterised by acute deterioration in attention and other mental functions. Mental and Behavioural Disorders

Interventions

Reference standard assessment including three-item recall (short- and long-term memory), orientation questions, attention tasks (20 to 1, Vigilance A and DelApp), DRS-R98, OSLA and RASS. Index assessm

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: 1. Surgical (cardiac and hip fracture) and medical patients with current delirium 2. Aged 70 years or older 3. Capacity to provide written, informed consent or the availability of a suitable relative or welfare guardian/attorney who is able to provide informed consent on behalf of the patient

Exclusion criteria

Exclusion criteria: 1. Unable to communicate in English (some of the cognitive tests used have not been validated in non-English speakers, hence the study only includes patients who can normally communicate fluently in English), including severe dysphasia. 2. Acute life-threatening illness requiring time-critical intervention. 3. Coma. 4. Vision or hearing impairment severe enough to preclude testing or interview. 5. Photosensitive epilepsy. 6. High level of patient and family distress, as judged by the clinical team.

Design outcomes

Primary

Measure	Time frame
Delirium recovery measured using brief questionnaires and observational scales (reference and index assessments). The index assessment consists of the 4AT test plus brief supplementary tests, specifically the Days of the Week Backwards test. This will be compared against a more comprehensive reference assessment (including Vigilance A test, DelApp, 20 to 1, DRS-R98) to assess attentional function, orientation, memory, psychotic features, etc. at baseline and up to 3 further assessment days in hospital.	—

Measure

Time frame

Delirium recovery measured using brief questionnaires and observational scales (reference and index assessments). The index assessment consists of the 4AT test plus brief supplementary tests, specifically the Days of the Week Backwards test. This will be compared against a more comprehensive reference assessment (including Vigilance A test, DelApp, 20 to 1, DRS-R98) to assess attentional function, orientation, memory, psychotic features, etc. at baseline and up to 3 further assessment days in hospital.

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Secondary

Measure	Time frame
1. Demographic and baseline variables such as age, medications, body measurements (height, weight, BMI), main reason for hospital admission, social history (including alcohol misuse and tobacco use) and health status (including dementia diagnosis or psychiatric/developmental condition), extracted from NHS electronic patient medical records at baseline. 2. Length of stay, institutionalisation, discharge location and mortality will be assessed at 12 weeks post-recruitment, also from NHS electronic patient medical records.	—

Measure

Time frame

1. Demographic and baseline variables such as age, medications, body measurements (height, weight, BMI), main reason for hospital admission, social history (including alcohol misuse and tobacco use) and health status (including dementia diagnosis or psychiatric/developmental condition), extracted from NHS electronic patient medical records at baseline. 2. Length of stay, institutionalisation, discharge location and mortality will be assessed at 12 weeks post-recruitment, also from NHS electronic patient medical records.

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Countries

Scotland, United Kingdom

Outcome results

None listed

Source: ISRCTN (via WHO ICTRP) · Data processed: Apr 3, 2026