Table of Contents
Definition
The Memorial Delirium Assessment Scale (MDAS) is a 10-item scale developed by Trzepacz et al. (1998) to assess delirium in older adults. The MDAS assesses four domains of delirium:
- Inattention: This domain assesses the patient’s ability to focus and maintain attention.
- Disorientation: This domain assesses the patient’s awareness of time, place, and person.
- Perceptual disturbances: This domain assesses the patient’s experience of hallucinations and delusions.
- Psychomotor disturbances: This domain assesses the patient’s level of activity and psychomotor behavior.
Reliability
The MDAS has good internal consistency, with Cronbach’s alpha coefficients ranging from .77 to .89 (Trzepacz et al., 1998). The MDAS also has good test-retest reliability, with correlations ranging from .75 to .85 (Trzepacz et al., 1998).
Validity
The MDAS has good construct validity. It has been shown to correlate with other measures of delirium, such as the Confusion Assessment Method (CAM) (Inouye et al., 1990) and the Delirium Rating Scale-Revised 98 (DRS-98) (Trzepacz et al., 1994). The MDAS has also been shown to be sensitive to change in delirium over time.
Use
The MDAS is a useful tool for diagnosing delirium in older adults. It can be used in a variety of settings, such as hospitals, nursing homes, and outpatient clinics. The MDAS is also a useful tool for monitoring the course of delirium over time.
Limitations
The MDAS is a clinician-administered scale, which means that it requires training to use. Additionally, the MDAS is a relatively new scale, and its use in other cultures may be limited.
Overall
The MDAS is a well-validated scale for diagnosing delirium in older adults. It is a useful tool for clinicians who are interested in identifying and treating delirium.
Memorial Delirium Assessment Scale (MDAS)
Rate the severity of the following symptoms of delirium based on current interaction with subject or assessment of his/her behavior or experience over last several hours (as indicated in each item.)
REDUCED LEVEL OF CONSCIOUSNESS (AWARENESS):
Rate the patient’s current awareness of and interaction with the environment (interviewer, other people/objects in the room; for example, ask patients to describe their surroundings). |
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DISORIENTATION:
Rate current state by asking the following 10 orientation items: date, month, day, year, season, floor, name of hospital, city, state, and country. |
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SHORT-TERM MEMORY IMPAIRMENT:
Rate current state by using repetition and delayed recall of 3 words [patient must immediately repeat and recall words 5 min later after an intervening task. Use alternate sets of 3 words for successive evaluations (for example, apple, table, tomorrow, sky, cigar, justice)]. |
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IMPAIRED DIGIT SPAN:
Rate current performance by asking subjects to repeat first 3, 4, then 5 digits forward and then 3, then 4 backwards; continue to the next step only if patient succeeds at the previous one. |
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REDUCED ABILITY TO MAINTAIN AND SHIFT ATTENTION:
As indicated during the interview by questions needing to be rephrased and/or repeated because patient’s attention wanders, patient loses track, patient is distracted by outside stimuli or over-absorbed in a task. |
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DISORGANIZED THINKING:
As indicated during the interview by rambling, irrelevant, or incoherent speech, or by tangential, circumstantial, or faulty reasoning. Ask patient a somewhat complex question (for example, “Describe your current medical condition.”). |
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PERCEPTUAL DISTURBANCE:
Misperceptions, illusions, hallucinations inferred from inappropriate behavior during the interview or admitted by subject, as well as those elicited from nurse/family/chart accounts of the past several hours or of the time since last examination. |
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DELUSIONS:
Rate delusions inferred from inappropriate behavior during the interview or admitted by the patient, as well as delusions elicited from nurse/family/chart accounts of the past several hours or of the time since the previous examination. |
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3 †severe (persistent and/or intense delusions resulting in inappropriate behavior, disrupting the interview or seriously interfering with medical care) |
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DECREASED OR INCREASED PSYCHOMOTOR ACTIVITY:
Rate activity over past several hours. |
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Rate activity during interview, as a) hypoactive, (b) hyperactive, or (c) elements of both present. | |
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SLEEP-WAKE CYCLE DISTURBANCE (DISORDER OF AROUSAL):
Rate patient’s ability to either sleep or stay awake at the appropriate times. Utilize direct observation during the interview, as well as reports from nurses, family, patient, or charts describing sleep-wake cycle disturbance over the past several hours or since last examination. Use observations of the previous night for morning evaluations only. |
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Interpretation
Developer
Number Of Questions
References
Breitbart W, et al. J Pain Symptom Manage. 1997 Mar;13(3):128-37.