4AT Assessment Calculator

[1] ALERTNESS

This includes patients who may be markedly drowsy (eg. difficult to rouse and/or obviously sleepy during assessment) or agitated/hyperactive. Observe the patient. If asleep, attempt to wake with speech or gentle touch on shoulder. Ask the patient to state their name and address to assist rating.

Normal (0) Mild sleepiness (0) Clearly abnormal (4)

[3] ATTENTION

Ask the patient: "Please tell me the months of the year in backwards order, starting at December." To assist initial understanding one prompt of "what is the month before December?" is permitted.

≥7 months correct (0) <7 months / refuses (1) Untestable (2)

Total Score: 0 / 12

Score 0: Patient is fully alert (but not agitated) throughout assessment OR briefly sleepy for <10 seconds after waking, then normal
Score 4: Patient exhibits any of these:
- Clearly abnormally drowsy
- Agitated/hyperactive
- Not fully alert throughout assessment

Tests patient's ability to correctly state:

Age
Date of birth
Place (name of hospital/building)
Current year

Score 0: No mistakes
Score 1: One mistake
Score 2: Two or more mistakes, or untestable

Patient is asked to list months in reverse order, starting from December.

Score 0: Recites 7 months or more correctly
Score 1: Starts but scores <7 months, or refuses to start
Score 2: Untestable (cannot start because unwell, drowsy, inattentive)

Evidence of significant change or fluctuation in:

Alertness
Cognition
Other mental function (e.g. paranoia, hallucinations)

Changes must have:

Arisen over the last 2 weeks
Still be evident in last 24hrs

Score 0: No evidence of acute change or fluctuation
Score 4: Evidence of significant change or fluctuation

About the 4AT

[1] Alertness scoring explanation

[2] AMT4 scoring explanation

[3] Attention scoring explanation

[4] Acute Change scoring explanation