Altered level of consciousness

If the patient's level of consciousness is determined to be anything other than alert the patient is considered to be positive for this feature.

Restlessnessagitation and fearfulness and hyper alertness are symptoms of hyperactive delirium and lethargystuporous or comatose states may reflect hypoactive delirium.


  • Vigilant: the respondent startles to any sound or touch. Eyes are wide open
  • Lethargic: the respondent repeatedly dozes off while you are asking questions. Difficult to keep respondent awake for interview, but does respond to voice or touch
  • Stupor: the respondent is very difficult to arouse and keep aroused for the interview, requiring shaking and/or repeated shouting
  • Coma: the respondent cannot be aroused despite shaking and shouting.

Reference: Inouye SK, vanDyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: The Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med. 1990; 113: 941-948. Confusion Assessment Method: Training Manual and Coding Guide, Copyright 2003, Sharon K. Inouye, M.D., MPH. Not to be reproduced without permission. Instructions for correct usage available at the Hospital Elder Life Program (HELP) website Linked to another web site, or on request from Dr. Sharon Inouye.