Fluctuation in behaviour
For each item of the CAM you are assessing for fluctuations from usual behaviour. Did the person's behaviour fluctuate during the interview period, that is, for example, were there times when the respondent's communication was clear and other times unclear? Did the behaviour seem to improve at some times and get worse at other times (increase and decrease in severity)?
How to assess:
Fluctuation in attention – At times respondent is able to focus on questions and keep track of what is being said. At other times, the interviewer cannot engage the respondent, who repeats answers or answers inappropriately.
Fluctuation in speech – At times respondent gives lucid, coherent answers, and at other times, gives incoherent or nonsense answers.
Fluctuation in level of consciousness – At times respondent is alert and responsive to all questions, while at other times respondent is lethargic, unresponsive, and difficult to arouse.
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 , or on request from Dr. Sharon Inouye.