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The Confusion Assessment Method (CAM)

A quick and simple method of screening patients in order to detect delirium is the Confusion Assessment Method. The CAM takes the form of a series of reflective questions which require some interpretation, followed by an algorithm based on the central features of delirium. The CAM is easy to use, it takes less than five minutes to complete after training in its use and it is well validated.

Feature 1. Acute onset and fluctuating course
The information for this feature is obtained from a family member or nurse and is shown by positive responses to the following questions: Is there evidence of an acute change in mental functioning from the patient’s usual? Does the (abnormal) behaviour fluctuate during the day that is, tend to come and go, or increase and decrease in severity?

Feature 2. Inattention
This feature is shown by a positive response to the following question:
Does the patient have difficulty focusing attention – for example, are they easily distracted, or do they have difficulty keeping track of what was being said?

Feature 3. Disorganised thinking
This feature is shown by a positive response to the following question:
Is the patient’s thinking disorganised or incoherent, such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?

Feature 4. Altered level of consciousness
This feature is shown if any answer other than ‘alert’ is given to the following question: Overall how would you rate this patient’s level of consciousness? Alert [normal], vigilant [hyper alert], lethargic [drowsy, easily aroused], stupor [difficult to arouse], or coma [unrousable].

The diagnosis of delirium by CAM requires the presence of features 1 and 2 and either 3 or 4.

See Inouye S, Van Dyck CH, Alessi CA, et al. 1990. Clarifying confusion : the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine 113: 941–8

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