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Using scores from the 4AT delirium detection tool as an indicator of possible dementia: a study of 75 221 older adult hospital admissions
Rose Penfold, Emily Bowman, Emma R. L. C. Vardy, Elizabeth L Sampson, Atul Anand, Bruce Guthrie, Alasdair M. J. MacLullich. Age and Ageing, 2025-05-14
Topic: Risk, prevention and care in population studies
Of 75 221 admissions, 62 188 (82.7%; 33 625 unique patients; mean age 80.2 years; 55.8% female) had a 4AT on admission. Of these, 9948 (16.0%) had a recorded clinical dementia diagnosis at the time of admission, with a further 1197 (1.9%) receiving a new diagnosis at discharge. Of admissions with dementia, 9669/11 145 (86.8%) had a 4AT score ≥1 on admission, compared to 14 994/51 043 (29.4%) without dementia.4AT ≥1 had a sensitivity of 0.87 (95% CI 0.86-0.87) and a specificity of 0.71 (0.70-0.71) in relation to clinical dementia diagnosis. 4AT ≥4 showed sensitivity of 0.50 (0.50-0.51) and a specificity of 0.88 (0.88-0.88). 4AT scores were associated with clinically diagnosed dementia. These results suggest that routinely collected 4AT scores could be leveraged in conjunction with other clinical indicators to identify patients with possible undiagnosed dementia who could undergo further inpatient diagnostic assessment and/or post-discharge specialist follow-up.
Key findings
- Of 75 221 admissions, 62 188 (82.7%; 33 625 unique patients; mean age 80.2 years; 55.8% female) had a 4AT on admission.
- Of these, 9948 (16.0%) had a recorded clinical dementia diagnosis at the time of admission, with a further 1197 (1.9%) receiving a new diagnosis at discharge.
- Of admissions with dementia, 9669/11 145 (86.8%) had a 4AT score ≥1 on admission, compared to 14 994/51 043 (29.4%) without dementia.4AT ≥1 had a sensitivity of 0.87 (95% CI 0.86-0.87) and a specificity of 0.71 (0.70-0.71) in relation to clinical dementia diagnosis. 4AT ≥4 showed sensitivity of 0.50 (0.50-0.51) and a specificity of 0.88 (0.88-0.88).
- These results suggest that routinely collected 4AT scores could be leveraged in conjunction with other clinical indicators to identify patients with possible undiagnosed dementia who could undergo further inpatient diagnostic assessment and/or post-discharge specialist follow-up.
Why it matters
Routinely collected 4AT scores were associated with clinically diagnosed dementia and could be used alongside other clinical indicators to identify patients with possible undiagnosed dementia for further assessment. This was an observational study of hospital admissions, not a test of any treatment or cure.
Study details
- Effect size82.7%; 55.8%; 16.0%
- Evidence strengthLow
How this study scored 46/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Age and Ageing) |
| Journal's citation record | 2 / 4 | Age and Ageing: journal h-index 231 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 8 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 5.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 3 other studies in this library |
| Still being cited | 1 / 4 | Cited 8 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Alasdair M. J. MacLullich: h-index 62 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Oxford: institution h-index 2,205 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 8 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40518970) |
| Free to read | 2 / 2 | Free to read |
| Total | 46 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Penfold, R., Bowman, E., Vardy, E. R. L. C., Sampson, E. L., Anand, A., Guthrie, B., et al. (2025). Using scores from the 4AT delirium detection tool as an indicator of possible dementia: a study of 75 221 older adult hospital admissions. Age and Ageing. https://doi.org/10.1093/ageing/afaf144
Vancouver
Penfold R, Bowman E, Vardy ERLC, Sampson EL, Anand A, Guthrie B, et al. Using scores from the 4AT delirium detection tool as an indicator of possible dementia: a study of 75 221 older adult hospital admissions. Age and Ageing. 2025. doi:10.1093/ageing/afaf144. PMID: 40518970.
BibTeX
@article{penfold2025-40518970,
author = {Penfold, Rose and Bowman, Emily and Vardy, Emma R. L. C. and Sampson, Elizabeth L and Anand, Atul and Guthrie, Bruce and MacLullich, Alasdair M. J.},
title = {{Using scores from the 4AT delirium detection tool as an indicator of possible dementia: a study of 75 221 older adult hospital admissions}},
journal = {Age and Ageing},
year = {2025},
doi = {10.1093/ageing/afaf144},
pmid = {40518970},
url = {https://doi.org/10.1093/ageing/afaf144}
}
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