Screening tools for depression, delirium and cognition
Which bedside tool to use for attention, cognition and depression in an older person, the cut-offs (4AT, CAM, MMSE, MoCA, RUDAS, KICA-Cog, GDS-15, Cornell), how to read a score against education, culture and senses, and what a score can and can't decide.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Test in this order: attention first (is this delirium?), then cognition, then mood. A delirious patient can't do a valid cognitive or depression screen.
- 4AT is the Australian default for delirium screening; CAM is the alternative.
- MoCA is the better screen for MCI and executive change; MMSE remains on PBS forms. RUDAS for culturally and linguistically diverse patients, KICA-Cog for Aboriginal and Torres Strait Islander people in remote communities.
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Sources
- Clinical Practice Guidelines and Principles of Care for People with DementiaAU/NZNHMRC Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People, 2016 (Monash-led update consulted on 11 May to 6 July 2026; final not yet released when checked November 2026)
- Updating the Clinical Practice Guidelines and Principles of Care for People with DementiaAU/NZMonash University, 2026 draft
- Delirium Clinical Care Standard (revised 2021)AU/NZAustralian Commission on Safety and Quality in Health Care, 2021 (current November 2026)
- Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis (Tieges Z et al. Age Ageing 2021;50:733-43)Age and Ageing, 2021
- Clarifying confusion: the confusion assessment method (Inouye SK et al. Ann Intern Med 1990;113:941-8)Annals of Internal Medicine, 1990
- Montreal Cognitive Assessment for the detection of dementia (Davis DH et al. Cochrane Database Syst Rev 2021;7:CD010775)Cochrane, 2021
- The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment (Nasreddine ZS et al. J Am Geriatr Soc 2005;53:695-9)Journal of the American Geriatrics Society, 2005
- The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale (Storey JE et al. Int Psychogeriatr 2004;16:13-31)AU/NZInternational Psychogeriatrics, 2004
- Kimberley Indigenous Cognitive Assessment tool (KICA): development of a cognitive assessment tool for older indigenous Australians (LoGiudice D et al. Int Psychogeriatr 2006;18:269-80)AU/NZInternational Psychogeriatrics, 2006
- The diagnostic accuracy of brief versions of the Geriatric Depression Scale: a systematic review and meta-analysis (Pocklington C et al. Int J Geriatr Psychiatry 2016;31:837-57)International Journal of Geriatric Psychiatry, 2016
- Cornell Scale for Depression in Dementia (Alexopoulos GS et al. Biol Psychiatry 1988;23:271-84)Biological Psychiatry, 1988
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy