On 2015 Apr 02, Alasdair MacLullich commented:

Thank you for the clarification. This is a very important issue because low arousal states of acute onset (excluding coma) are considered as indicating "severe inattention" in DSM-5: see the DSM-5 guidance notes.

Many patients with low arousal states (of acute onset) are not testable by conventional cognitive tests, and yet these patients mostly have delirium. Because of this, there is an explicit 'untestable' category in the 4AT, a rapid assessment test for delirium designed for use in routine clinical practice (see www.the4AT.com; http://www.ncbi.nlm.nih.gov/pubmed/24590568; http://www.ncbi.nlm.nih.gov/pubmed/23988641).

The issue of low arousal states and delirium diagnosis was covered in a consensus statement by the European Delirium Association and the American Delirium Society: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177077/

See also these two relevant papers: http://www.ncbi.nlm.nih.gov/pubmed/24080383; http://www.ncbi.nlm.nih.gov/pubmed/22173963

On 2015 Mar 15, Geriatric Medicine Journal Club commented:

Thank you so much. We will share this comment with a link to the followers of #GeriMedJC on Twitter.

On 2015 Mar 09, Edward R Marcantonio commented:

A recent Geriatric Medicine Journal Club commented on the limitations of the 3D-CAM in low arousal states. Note that for each 3D-CAM question, "no response" is considered the equivalent of "incorrect" and can trigger the presence of a CAM Feature. Therefore, the 3D-CAM should work equally well, and be even quicker, in patients with low arousal states. While we had relatively few patients with low arousal states in our validation study, the 3D-CAM correctly identified 100% of the delirium cases in this subgroup.

On 2015 Feb 27, Geriatric Medicine Journal Club commented:

This study of the 3D-CAM, a 3-minute diagnostic assessment for CAM-defined delirium, was critically appraised at the November 2014 Geriatric Medicine Journal Club (follow #GeriMedJC on Twitter). Much discussion was generated between researchers and clinicians from around the world. See the full transcript of the discussion here: http://gerimedjc.blogspot.com/2014/11/gerimedjc-november-28-2014.html?spref=tw Highlights included limitations of assessment in patients with low-arousal states.

On 2015 Feb 27, Geriatric Medicine Journal Club commented:

This study of the 3D-CAM, a 3-minute diagnostic assessment for CAM-defined delirium, was critically appraised at the November 2014 Geriatric Medicine Journal Club (follow #GeriMedJC on Twitter). Much discussion was generated between researchers and clinicians from around the world. See the full transcript of the discussion here: http://gerimedjc.blogspot.com/2014/11/gerimedjc-november-28-2014.html?spref=tw Highlights included limitations of assessment in patients with low-arousal states.

On 2015 Mar 09, Edward R Marcantonio commented:

A recent Geriatric Medicine Journal Club commented on the limitations of the 3D-CAM in low arousal states. Note that for each 3D-CAM question, "no response" is considered the equivalent of "incorrect" and can trigger the presence of a CAM Feature. Therefore, the 3D-CAM should work equally well, and be even quicker, in patients with low arousal states. While we had relatively few patients with low arousal states in our validation study, the 3D-CAM correctly identified 100% of the delirium cases in this subgroup.

On 2015 Apr 02, Alasdair MacLullich commented:

Thank you for the clarification. This is a very important issue because low arousal states of acute onset (excluding coma) are considered as indicating "severe inattention" in DSM-5: see the DSM-5 guidance notes.

Many patients with low arousal states (of acute onset) are not testable by conventional cognitive tests, and yet these patients mostly have delirium. Because of this, there is an explicit 'untestable' category in the 4AT, a rapid assessment test for delirium designed for use in routine clinical practice (see www.the4AT.com; http://www.ncbi.nlm.nih.gov/pubmed/24590568; http://www.ncbi.nlm.nih.gov/pubmed/23988641).

The issue of low arousal states and delirium diagnosis was covered in a consensus statement by the European Delirium Association and the American Delirium Society: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177077/

See also these two relevant papers: http://www.ncbi.nlm.nih.gov/pubmed/24080383; http://www.ncbi.nlm.nih.gov/pubmed/22173963