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MDAS: Memorial Delirium Assessment Scale

1997

Ten-item severity measure developed in cancer and AIDS inpatients; suited to repeated assessments in research and palliative settings.

At a glance

Purpose
Measurement of delirium severity
Population
Adult
Setting
Palliative care, General / acute hospital
Time
variable
Items
10
Score or threshold
0–30 severity score; ≥13 was evaluated as a diagnostic threshold in original Study 1

Format: The instrument records 10 scored items or observations. This site classifies it under measurement of delirium severity. It is intended for adult use in Palliative care, General / acute hospital. The stated administration time is variable. The published result is recorded using Continuous severity (0–30).

  • Strengths: Repeatable severity measure; strong in palliative/oncology
  • Limitations: Designed primarily to measure delirium severity rather than as a standalone diagnostic screen; diagnostic thresholds vary between studies and settings

Primary validation papers

15 identified diagnostic-accuracy papers

Other forms of validation are described in the evidence section. What is counted?

Large-scale clinical implementation

None identified in the scoped review.

None identified in the selected profile sources and the Penfold general-hospital review. This is not a completed search of all settings or later papers.

Training and instructions

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Tool and original sources

A source for the tool or its access information is linked below. Check the version and current terms before use, copying or adaptation.

View the hosted tool ↗ Search Google Images ↗ NIDUS information cards ↗

Original and selected diagnostic-accuracy papers

  • Original paperBreitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S. The Memorial Delirium Assessment Scale. Journal of pain and symptom management. 1997;13(3):128-37. doi: 10.1016/s0885-3924(96)00316-8. PMID: 9114631.

    This is the original published source for MDAS. It reported sensitivity of 70.59% and specificity of 93.75% against a DSM-IV clinical assessment.

    Open PubMed ↗
  • Selected diagnostic-accuracy studyLawlor PG, Nekolaichuk C, Gagnon B, Mancini IL, Pereira JL, Bruera ED. Clinical utility, factor analysis, and further validation of the memorial delirium assessment scale in patients with advanced cancer: Assessing delirium in advanced cancer. Cancer. 2000;88(12):2859-67. doi: 10.1002/1097-0142(20000615)88:12<2859::aid-cncr29>3.0.co;2-t. PMID: 10870073.

    This diagnostic-accuracy study evaluated MDAS in tertiary acute palliative-care unit in a university-affiliated teaching hospital against a DSM-IV clinical assessment. It reported sensitivity of 98% and specificity of 96% in 104 consecutive advanced-cancer admissions; 330 complete MDAS ratings for cut-off analysis.

    Open PubMed ↗
  • Selected diagnostic-accuracy studyGrassi L, Caraceni A, Beltrami E, Borreani C, Zamorani M, Maltoni M, et al. Assessing delirium in cancer patients: the Italian versions of the Delirium Rating Scale and the Memorial Delirium Assessment Scale. Journal of pain and symptom management. 2001;21(1):59-68. doi: 10.1016/s0885-3924(00)00241-4. PMID: 11223315.

    This diagnostic-accuracy study evaluated MDAS in multicentre Italian oncology/palliative-care population against CAM criteria plus clinical examination. It reported sensitivity of 68% and specificity of 94% in 105 cancer patients referred for mental-status change.

    Open PubMed ↗
Multiple DTA studies identifiedCore instrument family
Classification

Classification

Measurement of delirium severity

A tool may belong to more than one category. Select a linked category to see other relevant profiles.

Evidence

Diagnostic-accuracy evidenceMultiple DTA studies identified

Reported sensitivity and specificity

Headline metric source

Original/source study · 1997; pmid:9114631

Denominator
33 patients
Reference standard
Study 1 DSM-III-R/DSM-IV delirium versus non-delirium clinical classification
70.59%
Sensitivity
93.75%
Specificity

Original 1997 Study 1 estimates at MDAS ≥13 (n=33). Study 2 (n=51) had no non-delirious comparator and contributed correlations only; do not combine the cohorts or use 84 as the diagnostic-performance denominator.

Expanded evidence profile

What the broader evidence shows

Interpretation: MDAS is best supported as a repeatable measure of delirium severity. Diagnostic thresholds have also been studied, particularly in cancer and palliative-care populations, but their performance varies markedly by population, cognitive impairment and study method; MDAS should not be treated as a universal standalone diagnostic rule.

Evidence snapshots

  • Original validation (1997): In the 33-patient diagnostic comparison, an MDAS threshold of 13 or more gave 70.6% sensitivity and 93.8% specificity; a separate 51-patient delirium cohort supported severity validity rather than diagnostic accuracy.
  • Advanced-cancer validation (2000): Among 104 consecutive admissions and 330 complete serial ratings, a threshold of 7 gave about 98% sensitivity and 96% specificity, although the repeated ratings and linked clinical assessment limit interpretation as independent patient-level accuracy.
  • Severity-instrument review (2019): A systematic review identified MDAS among six multidomain delirium-severity instruments with the strongest measurement properties.
  • Older cancer cohort (2023): In 75 older patients with cancer, sensitivity was 88% but specificity only 30%, illustrating how cognitive impairment and case mix can undermine a diagnostic threshold.

These results come from different populations and workflows and should not be averaged or treated as interchangeable.

8 selected PubMed-indexed papers, 1997–2023
  1. 1997Original validation study
    Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S. The Memorial Delirium Assessment Scale. J Pain Symptom Manage. 1997;13(3):128-137. doi: 10.1016/S0885-3924(96)00316-8. PMID: 9114631.

    The original paper developed the ten-item MDAS in two studies: a 33-patient diagnostic comparison and a separate 51-patient delirium cohort used for reliability and severity validity. At a threshold of 13 or more in Study 1, sensitivity was 70.59% and specificity 93.75%; the two cohorts must not be combined into one diagnostic denominator.

    PubMed · PMID 9114631 ↗
  2. 2000Further validation study
    Lawlor PG, Nekolaichuk C, Gagnon B, Mancini IL, Pereira JL, Bruera ED. Clinical utility, factor analysis, and further validation of the Memorial Delirium Assessment Scale in patients with advanced cancer. Cancer. 2000;88(12):2859-2867. doi: 10.1002/1097-0142(20000615)88:12<2859::AID-CNCR29>3.0.CO;2-T. PMID: 10870073.

    This acute palliative-care study included 104 consecutive advanced-cancer admissions and analysed 330 complete serial MDAS ratings. A threshold of 7 gave approximately 98% sensitivity and 96% specificity, but repeated observations and a clinically linked reference process mean the estimate is not a simple independent patient-level diagnostic test.

    PubMed · PMID 10870073 ↗
  3. 2008Diagnostic-threshold study
    Kazmierski J, Kowman M, Banach M, Fendler W, Okonski P, Banys A, et al. Clinical utility and use of DSM-IV and ICD-10 criteria and the Memorial Delirium Assessment Scale in establishing a diagnosis of delirium after cardiac surgery. Psychosomatics. 2008;49(1):73-76. doi: 10.1176/appi.psy.49.1.73. PMID: 18212180.

    This prospective cardiac-surgery cohort evaluated MDAS alongside DSM-IV and ICD-10 diagnostic criteria in 260 patients. A threshold of 10 was reported as optimal, with 97% sensitivity and 96% specificity, but the result comes from a single postoperative population and should not be generalised to severity monitoring in other settings.

    PubMed · PMID 18212180 ↗
  4. 2014Diagnostic-accuracy study
    Shi Z, Wu Y, Li C, Fu S, Li G, Zhu Y, et al. Using the Chinese version of Memorial Delirium Assessment Scale to describe postoperative delirium after hip surgery. Front Aging Neurosci. 2014;6:297. doi: 10.3389/fnagi.2014.00297. PMID: 25414664.

    This single-centre hip-surgery study assessed 82 older patients with a Chinese MDAS and compared it with CAM classification. The area under the curve was 0.990 and a threshold of 7.5 gave 90.5% sensitivity and 98.4% specificity, but CAM was an instrument comparator rather than an independent specialist DSM assessment.

    PubMed · PMID 25414664 ↗
  5. 2019Systematic review of severity instruments
    Jones RN, Cizginer S, Pavlech L, Albuquerque A, Daiello LA, Dharmarajan K, et al. Assessment of Instruments for Measurement of Delirium Severity: A Systematic Review. JAMA Intern Med. 2019;179(2):231-239. doi: 10.1001/jamainternmed.2018.6975. PMID: 30556827.

    This systematic review examined the measurement properties of delirium-severity instruments rather than diagnostic screening alone. MDAS was one of six multidomain instruments judged to have the strongest overall evidence, reinforcing its principal role as a severity measure.

    PubMed · PMID 30556827 ↗
  6. 2020Validation study
    Klankluang W, Pukrittayakamee P, Atsariyasing W, Siriussawakul A, Chanthong P, Tongsai S, et al. Validity and Reliability of the Memorial Delirium Assessment Scale-Thai Version (MDAS-T) for Assessment of Delirium in Palliative Care Patients. Oncologist. 2020;25(2):e335-e340. doi: 10.1634/theoncologist.2019-0399. PMID: 32043769.

    This Thai palliative-care validation included 194 patients and used DSM-5 diagnosis as the reference standard. A threshold of 9 gave an area under the curve of 0.96, 92% sensitivity and 90% specificity, with a median administration time of about five minutes.

    PubMed · PMID 32043769 ↗
  7. 2021Systematic review
    Yang EJ, Hahm BJ, Shim EJ. Screening and Assessment Tools for Measuring Delirium in Patients with Cancer in Hospice and Palliative Care: A Systematic Review. J Hosp Palliat Care. 2021;24(4):214-225. doi: 10.14475/jhpc.2021.24.4.214. PMID: 37674643.

    This review mapped delirium instruments used in hospice and palliative cancer care across 81 studies and examined psychometric evidence in ten studies. MDAS was the most frequently validated instrument in that subset, but the review also showed that populations, purposes and thresholds varied.

    PubMed · PMID 37674643 ↗
  8. 2023Exploratory diagnostic-accuracy study
    Llisterri-Sánchez P, Benlloch M, Pérez-Ros P. The Confusion Assessment Method Could Be More Accurate than the Memorial Delirium Assessment Scale for Diagnosing Delirium in Older Cancer Patients: An Exploratory Study. Curr Oncol. 2023;30(9):8245-8254. doi: 10.3390/curroncol30090598. PMID: 37754513.

    This exploratory study compared MDAS and CAM with two oncologists applying DSM-5 criteria in 75 older patients with cancer. MDAS sensitivity was 88% but specificity only 30%, suggesting that cognitive impairment and a high-prevalence specialist sample can make a diagnostic threshold over-inclusive.

    PubMed · PMID 37754513 ↗

This is a selected evidence overview, not a systematic review. The panel prioritises the original study, major validation work, systematic reviews and clinically informative recent studies; all eight records were checked in PubMed, with citation-network screening in OpenAlex and integrity checks in Scite, on 31 August 2026.

More evidence and citation details
Full name
Memorial Delirium Assessment Scale
Also known as
MDAS
Evidence summary
multi
Diagnostic-accuracy evaluations
15
Reference standard
Study 1 delirium/non-delirium clinical classification reported in the source article
Reliability
Inter-rater 0.92; α 0.91
Citation
Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S The Memorial Delirium Assessment Scale Journal of pain and symptom management. 1997;13(3):128-37. PMID 9114631
Download RIS ↗ Download BibTeX ↗

Primary validation studies

Distinct primary publications from the current diagnostic-accuracy audit. Reviews and repeated evaluations within one paper are not counted again. Overlapping cohorts have not all been reconciled. Read the counting rules and limitations.

Open 15 identified papers
  1. Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S (1997). The Memorial Delirium Assessment Scale. Journal of pain and symptom management.

    Reference category: other comparator or secondary accuracy evidence.

  2. Lawlor PG, Nekolaichuk C, Gagnon B, Mancini IL, Pereira JL, Bruera ED (2000). Clinical utility, factor analysis, and further validation of the memorial delirium assessment scale in patients with advanced cancer: Assessing delirium in advanced cancer. Cancer.

    Reference category: other comparator or secondary accuracy evidence.

  3. Grassi L, Caraceni A, Beltrami E, Borreani C, Zamorani M, Maltoni M, Monti M, Luzzani M, Mercadante S, De Conno F (2001). Assessing delirium in cancer patients: the Italian versions of the Delirium Rating Scale and the Memorial Delirium Assessment Scale. Journal of pain and symptom management.

    Reference category: other comparator or secondary accuracy evidence.

  4. Matsuoka Y, Miyake Y, Arakaki H, Tanaka K, Saeki T, Yamawaki S (2001). Clinical utility and validation of the Japanese version of Memorial Delirium Assessment Scale in a psychogeriatric inpatient setting. General hospital psychiatry.

    Reference category: other comparator or secondary accuracy evidence.

  5. Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA (2005). Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. Journal of pain and symptom management.

    Reference category: other comparator or secondary accuracy evidence.

  6. Kazmierski J, Kowman M, Banach M, Fendler W, Okonski P, Banys A, Jaszewski R, Sobow T, Kloszewska I (2008). Clinical utility and use of DSM-IV and ICD-10 Criteria and The Memorial Delirium Assessment Scale in establishing a diagnosis of delirium after cardiac surgery. Psychosomatics.

    Reference category: other comparator or secondary accuracy evidence.

  7. Shyamsundar G, Raghuthaman G, Rajkumar AP, Jacob KS (2009). Validation of memorial delirium assessment scale. Journal of critical care.

    Reference category: independent clinical reference.

  8. Sands MB, Dantoc BP, Hartshorn A, Ryan CJ, Lujic S (2010). Single Question in Delirium (SQiD): testing its efficacy against psychiatrist interview, the Confusion Assessment Method and the Memorial Delirium Assessment Scale. Palliative medicine.

    Reference category: other comparator or secondary accuracy evidence.

  9. Kazmierski J, Kowman M, Banach M, Fendler W, Okonski P, Banys A, Jaszewski R, Rysz J, Sobow T, Kloszewska I (2010). The use of DSM-IV and ICD-10 criteria and diagnostic scales for delirium among cardiac surgery patients: results from the IPDACS study. The Journal of neuropsychiatry and clinical neurosciences.

    Reference category: other comparator or secondary accuracy evidence.

  10. Shi Z, Wu Y, Li C, Fu S, Li G, Zhu Y, Swain CA, Marcantonio ER, Xie Z, Shen Y (2014). Using the Chinese version of Memorial Delirium Assessment Scale to describe postoperative delirium after hip surgery. Frontiers in aging neuroscience.

    Reference category: other comparator or secondary accuracy evidence.

  11. Barahona E, Pinhao R, Galindo V, Noguera A (2018). The Diagnostic Sensitivity of the Memorial Delirium Assessment Scale-Spanish Version. Journal of pain and symptom management.

    Reference category: other comparator or secondary accuracy evidence.

  12. Kang B, Kim YJ, Suh SW, Son KL, Ahn GS, Park HY (2019). Delirium and its consequences in the specialized palliative care unit: Validation of the Korean version of Memorial Delirium Assessment Scale. Psycho-oncology.

    Reference category: other comparator or secondary accuracy evidence.

  13. Klankluang W, Pukrittayakamee P, Atsariyasing W, Siriussawakul A, Chanthong P, Tongsai S, Tayjasanant S (2020). Validity and Reliability of the Memorial Delirium Assessment Scale-Thai Version (MDAS-T) for Assessment of Delirium in Palliative Care Patients. The oncologist.

    Reference category: independent clinical reference.

  14. Hu CH, Chiu YC, Liu SI, Ko KT (2022). Validating the Mandarin version of the Memorial delirium assessment scale in general medical hospital patients. Asia-Pacific psychiatry : official journal of the Pacific Rim College of Psychiatrists.

    Reference category: independent clinical reference.

  15. Llisterri-Sánchez P, Benlloch M, Pérez-Ros P (2023). The Confusion Assessment Method Could Be More Accurate than the Memorial Delirium Assessment Scale for Diagnosing Delirium in Older Cancer Patients: An Exploratory Study. Current oncology (Toronto, Ont.).

    Reference category: independent clinical reference.

Copyright and reuse
Information checked
2026-07-19

Instrument-specific terms apply. See the access and copyright policy or send a correction.

Base clinical review: 2026-07-24. Instrument description source check: 2026-09-05. Scope and limitations.