Reference Standard for Delirium: DSM-5 Criteria

DSM-5 Criteria

A) Disturbance in attention and awareness

  • Attention: ie, reduced ability to direct, focus, sustain, and shift attention.
  • Awareness: ie, reduced orientation to the environment.

B) Develops over a short period (hours to days)

  • The disturbance develops over a short period of time (usually hours to a few days)
  • Signifies acute change from baseline attention and awareness.
  • Tends to fluctuate in severity during the course of a day.

C) Additional disturbance in cognition

  • memory deficit
  • disorientation
  • language
  • visuospatial ability
  • or perception

D) Criteria A and C (attention and cognition)

The disturbances in Criteria A and C are

  • not better explained by a pre-existing, established, or evolving neurocognitive disorder
  • and do not occur in the context of a severely reduced level of arousal such as coma.

Key Point

Not feasible to perform in most EDs

Delirium is a clinical diagnosis. The reference standard for delirium is considered to be a psychiatrist evaluation using DSM-5 criteria, but it requires significant training to do reliably. A proper delirium evaluation can take approximately 30 to 45 minutes to perform. Therefore, detecting delirium using DSM-5 criteria is not feasible for most ED settings.


American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth ed. Arlington, VA: American Psychiatric Association; 2013.


DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

ED, emergency department

VA, Virginia