4-DSD: 4-Delirium Superimposed on Dementia
2021A four-item assessment developed specifically for delirium superimposed on moderate-to-severe dementia. Its multicentre derivation and validation cohort included acute and rehabilitation wards; at a cut-off of 5 or more, reported sensitivity and specificity were both 80%, with lower specificity in the small severe-dementia subgroup. Despite its name and developer-site location, 4-DSD is a separate instrument and is not a version or adaptation of 4AT.
Classification
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Tool and original sources
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Original paper
- Original paperMorandi A, Grossi E, Lucchi E, Zambon A, Faraci B, Severgnini J, et al. The 4-DSD: A New Tool to Assess Delirium Superimposed on Moderate to Severe Dementia. Journal of the American Medical Directors Association. 2021;22(7):1535-1542.e3. doi: 10.1016/j.jamda.2021.02.029. PMID: 33823162.
This is the original published source for 4-DSD. It reported sensitivity of 80% and specificity of 80% against an independent DSM-5 clinical assessment.
At a glance
- Purpose
- Episodic assessment
- Population
- Adult
- Setting
- General / acute hospital, Rehabilitation / post-acute
- Time
- ~3 min
- Items
- 4
- Score or threshold
- ≥5 of 12
Format: A four-item clinician assessment developed for delirium superimposed on moderate-to-severe dementia and evaluated in acute and rehabilitation wards. Scores range from 0 to 12; the study evaluated a threshold of 5 or more.
- Strengths: Designed specifically for moderate-to-severe dementia; includes acute change/fluctuation and function
- Limitations: One principal validation cohort; specificity was 56% in the small severe-dementia subgroup (n=26)
Evidence
Reported sensitivity and specificity
Original/source study · 2021 — pmid:33823162
- Denominator
- Reported source unit: 134 (analysis unit not fully reconciled)
- Reference standard
- Independently completed DSM-5 delirium assessment
Cut-off ≥5 vs DSM-5 (n=134). The cohort comprised 80 acute-ward participants (60%) and 54 rehabilitation-ward participants (40%); in severe dementia (n=26), sensitivity was 82% and specificity 56%.
More evidence and citation details
- Full name
- 4-Delirium Superimposed on Dementia
- Also known as
- 4-DSD, 4 Delirium Superimposed on Dementia
- Evidence summary
- single
- Diagnostic-accuracy studies
- 1
- Reference standard
- DSM-5
- Citation
- Morandi A, Grossi E, Lucchi E, Zambon A, Faraci B, Severgnini J, MacLullich A, Smith H, Pandharipande P, Rizzini A, Galeazzi M, Massariello F, Corradi S, Raccichini A, Scrimieri A, Morichi V, Gentile S, Lucchini F, Pecorella L, Mossello E, Cherubini A, Bellelli G The 4-DSD: A New Tool to Assess Delirium Superimposed on Moderate to Severe Dementia Journal of the American Medical Directors Association. 2021;22(7):1535-1542.e3. PMID 33823162
Copyright and reuse
- Version
- Use the current version supplied by the developer page
- Information checked
- 2026-07-19
Instrument-specific terms apply. See the access and copyright policy or send a correction.
Sources checked 2026-07-29. How profiles are prepared.