Is the patient hyper-alert, drowsy or difficult to rouse? Was the patient's conversation rambling and incoherent? Did they demonstrate an unclear or illogical flow of ideas? Did they switch rapidly from subject to subject? Ability to recite months of the year backwards is another good test for inattention. Did the patient have difficulty focusing attention, for example, being easily distractible, or having difficulty keeping track of what was being said? This can be assessed whilst talking to the patient, or, for example inability to count backwards from 20-1. Should be easily obtained from a collateral history. Delirium can be diagnosed when items 1 and 2 are present, and either item 3 or item 4, as follows: NICE guidance recommends use of the Confusion Assessment Method for diagnosis of delirium. The Single Question in Delirium test can pick up 80 per cent of patients with delirium by asking the question: "Do you think has been more confused lately?" Often patients may be labelled as "not themselves," "generally unwell," or "generally deteriorating." Even where patients do not meet all the criteria for a diagnosis of delirium, they may benefit from the approach to diagnosis and management outlined below, bearing in mind the other diagnoses that may be relevant to presentations such as reduced mobility. withdrawal, lack of co-operation for reasonable requests, alterations in mood, change in communication/attitude. reduced mobility, agitation, sleep disturbance.
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