Use a validated screen appropriate to the situation — the Mini-Cog for a brief screen, a more detailed instrument such as the MoCA where indicated, and the Confusion Assessment Method (CAM) when an acute change suggests delirium.
Assess orientation, recent and remote memory, attention, and executive function through structured tasks and conversation.
Establish the time course with the patient and caregiver — acute and fluctuating versus chronic and progressive — since this is the key to distinguishing delirium from dementia.
Distinguish delirium (acute onset, fluctuating, inattention, and an altered level of consciousness — evaluate urgently for a medical cause) from dementia (chronic and progressive with a stable level of consciousness) and from depression-related cognitive complaints.
Compare to the patient's baseline and assess the safety and decision-making implications.
