Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Acute brain, mood or sensory danger
New inattention or reduced alertness, suicidal intent, acute psychosis, focal neurology, sudden visual loss, painful red eye or sudden hearing loss requires urgent cause-specific care rather than routine screening.
Action: Stabilise physiology, check glucose and medication exposure, use the delirium or neurological pathway, protect the person from immediate self-harm or sensory loss, obtain collateral and involve acute medicine, mental health, ophthalmology or ENT as indicated.
Synopsis
Detect delirium, longer-term cognitive disorder, depression and hearing or visual impairment using accessible validated screening, interpret results against baseline and communication barriers, and arrange diagnostic assessment and immediate risk management.
Screening identifies who needs further assessment; it does not establish dementia, depression, incapacity or a specific sensory diagnosis by itself.
First priority for new cognitive change is delirium assessment with 4AT and a search for underlying causes; dementia and delirium commonly coexist.
Establish cognition and function before illness from collateral, then optimise hearing, vision, language, pain and arousal before longer-term testing.
Key red flags
Acute or fluctuating confusion, inattention, drowsiness or agitation is delirium until assessed, including in a person with known dementia.
Delirium pattern
Acute onset, fluctuation, inattention and altered arousal point to brain failure from illness or medication and require immediate cause assessment.
Investigation priorities
01
4AT delirium screenFirst step
Identify possible delirium rapidly in acute care.
Management branches
First cognitive sequenceDelirium first, then persistent cognition
A cognitive concern is new or its chronology is uncertain.
Optimise communication, obtain baseline collateral and use 4AT while assessing acute physiology and medicines.
Treat underlying causes and repeat cognition after fluctuation, arousal, pain and sensory barriers improve.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.