Summary

What it measures:

The Confusion Assessment Method (CAM) is used to detect delirium, quickly and accurately, in people at risk for dementia. (1) Although the CAM does not diagnose dementia, it is appropriate to use the tool with preexisting cognitive, emotional, psychiatric, or neurologic conditions. (2) The original 9-item CAM identifies delirium using the following criteria: acute onset and fluctuation, inattention, disorganized thinking, altered level of consciousness, disorientation, memory impairment, perceptual disturbances, psychomotor agitation or retardation, and altered sleep-wake cycle.

A short CAM version is also available for a quicker assessment, which eliminates the last 5 components and only includes the first 4 from the original algorithm. The short version is what is most commonly used in clinical practice. Adaptations of the CAM have been developed for special populations such as pediatrics, (3) caregivers and family members via the Family CAM, (4) and the ICU, when patients are nonverbal due to intubation, tracheostomy, or aphasic.

The Family Confusion Assessment Method (FAM-CAM) is an informant-based variation of the CAM in which a family member or caregiver assesses the patient's mental and cognitive status using a series of questions. Clinicians or experts on delirium ask family members or caregivers these questions in person, by telephone, or electronically. (5) They will ask about the patient’s recent mental and cognitive status, sleeping patterns, and abnormal actions or dialogue. The FAM-CAM can be used in both clinical and research settings, where it can be useful for facilitating and educating caregivers about possible acute changes in mental status, and early signs of cognitive changes in older individuals. It also may be used in clinical settings where delirium cannot be readily assessed by health care professionals (e.g., hospitals, ICUs, presurgery or postsurgery, postdischarge, or extended care settings). (5)

Conditions and test variations included in this summary

This summary contains information about the standard CAM and the sensitivity method and specificity method. A summary of the FAM-CAM is also included. The CAM and FAM-CAM are used for patients with suspected delirium.

Target Population:

This summary contains information about the standard CAM and the sensitivity method and specificity method. The tests are used on patients with suspected delirium.

Taskforce Recommendations

The Hospital Elder Life Program (HELP) is designed to provide care to older persons in the hospital. The program is an evidence-based, patient–care-centered program. HELP recommends using CAM (21) and FAM-CAM (5) to aid in diagnosing and preventing delirium.

The American Geriatric Society recommends early diagnosis of delirium using CAM to decrease mortality rates associated with delirium. (21)

CAM is recommended by the Cognitive and Mental Health Special Interest Group of the Academy of Geriatric Physical Therapy.

Clinical Insight

FAM-CAM is used to screen for delirium in all settings where access to a caregiver is possible. It is a tool that can be used by caregivers to note cognitive changes in a family member, and provides useful information if a family member presents to the emergency department or to another health service provider. (20) Use of FAM-CAM is also suggested to empower caregivers to identify exact changes in observable behavior and search for the cause of the changes, although more research is needed on increased levels of attentiveness after administration of FAM-CAM.