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Printed on 7/21/2026
For informational purposes only. This is not medical advice.
The Memorial Delirium Assessment Scale (MDAS) is a clinician-rated delirium instrument scoring 10 symptom domains from 0 to 3 each (total 0-30). It is used for both delirium screening support and longitudinal severity tracking in medical, oncology, and palliative settings.
Formula: MDAS total = sum of 10 symptom-domain scores (0-3 each), total range 0-30.
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The MDAS is clinician-rated and requires a structured assessment of 10 delirium-related symptom domains. Each domain is scored 0 (absent) to 3 (severe). The 10 domains assessed are: (1) reduced level of consciousness/arousal; (2) disorientation to time, place, or person; (3) short-term memory impairment; (4) impaired digit span (forward recall of digit sequences); (5) reduced capacity to maintain and shift attention; (6) disorganized thinking; (7) perceptual disturbances (illusions, hallucinations); (8) delusions; (9) decreased or increased psychomotor activity; and (10) disturbance of the sleep-wake cycle. The assessment is based on direct patient examination and is typically performed by a physician, clinical psychologist, or advanced practice nurse trained in the MDAS protocol.
After rating each of the 10 domains, the total MDAS score is calculated by simple summation, yielding a range of 0 to 30. Higher scores indicate greater delirium symptom burden. The total score is clinically interpretable as a severity metric: scores below 7 indicate minimal or no delirium signal; scores in the 7–12 range indicate subsyndromal or mild delirium-range symptoms warranting close monitoring; scores of 13 or above meet the commonly cited MDAS threshold for delirium; and scores above 20 indicate severe delirium with significant symptom burden. The MDAS is most valuable when applied serially — repeat MDAS assessments at 24–48 hour intervals allow tracking of delirium trajectory and response to treatment.
The MDAS score should be interpreted within the full clinical context: patient medical history, baseline cognitive status, medication review, metabolic parameters, imaging findings, and caregiver observations. An MDAS score above 13 confirms significant delirium symptom burden, but the underlying cause must be identified and treated for symptoms to resolve. Key reversible causes to evaluate include: infection (blood cultures, urinalysis, chest X-ray), medication toxicity (opioids, benzodiazepines, anticholinergics, steroids), metabolic derangement (sodium, glucose, calcium, BUN, creatinine), constipation and urinary retention, hypoxia, pain, sleep deprivation, and sensory deprivation. In oncology and palliative care settings specifically, MDAS is used to guide the intensity of symptom management including antipsychotic dosing and sedation decisions.
Oncology physicians, oncology nurses, hematologists, palliative care physicians
The MDAS was specifically developed for use in oncology populations and has the strongest validation evidence in cancer patients receiving chemotherapy, undergoing bone marrow transplantation, or entering palliative phases of advanced malignancy. In these populations, delirium is extremely common (affecting 25–85% of advanced cancer patients), has multiple simultaneous precipitants (opioids, steroids, electrolyte abnormalities, brain metastases, infection), and requires serial severity monitoring to guide treatment intensity. The MDAS total score guides antipsychotic dosing decisions (haloperidol, olanzapine, risperidone) and allows oncology teams to document delirium severity changes in response to pharmacological management or dose adjustments.
Palliative care physicians, palliative care nurses, hospice teams
Delirium occurs in 50–88% of patients in the final days to weeks of life and is one of the most distressing symptoms for patients, families, and healthcare teams. The MDAS provides a quantitative severity metric for terminal delirium that guides the intensity of palliative management — including decisions about sedation for refractory agitated delirium. Serial MDAS assessments document the trajectory of delirium as a symptom at end of life, support family communication about prognosis (worsening MDAS scores correlate with shorter survival in terminal cancer), and enable structured documentation of symptom management effectiveness in palliative care case records.
Delirium researchers, clinical trialists, academic geriatricians, psychiatrists
The MDAS is one of the most widely used outcome measures in delirium clinical trials due to its continuous 0–30 scale, clinician-rating design, multi-domain coverage, and established psychometric properties. Clinical trials testing pharmacological interventions for delirium (haloperidol versus quetiapine, prophylactic antipsychotics, melatonin), non-pharmacological interventions (multicomponent delirium prevention bundles), and sedation protocols in the ICU routinely use MDAS total scores as primary or secondary outcome measures. Its sensitivity to change over time makes the MDAS suitable for tracking treatment response as a continuous endpoint in intervention trials.
Intensivists, ICU nurses, anesthesiologists, surgical co-management teams
In the ICU and post-operative setting, the MDAS can be applied to characterize delirium severity in patients who are arousable and able to participate in a brief assessment. The 10-domain structure captures the full clinical spectrum of ICU delirium presentations, including hypoactive delirium (elevated arousal and psychomotor domains), hyperactive delirium (elevated agitation, perceptual disturbance, and disorganized thinking domains), and mixed-type delirium. MDAS serial scores in ICU patients can inform sedation titration decisions and document the relationship between sedation intensity and delirium severity over the ICU stay.
Neurologists, stroke unit nurses, rehabilitation physicians
Delirium complicates 10–48% of acute strokes and is independently associated with worse functional outcome, longer hospitalization, and increased mortality after stroke. In stroke and neurology units, the MDAS provides a detailed delirium severity assessment that captures subtle cognitive and behavioral changes relevant to neurological delirium presentation. The attention, disorientation, and psychomotor domains are particularly sensitive to neurological delirium features, and serial MDAS scores can track neurological delirium evolution during the acute stroke period and through early rehabilitation. The MDAS is complementary to the [CAM](/tools/cam-delirium) and [4AT](/tools/4at-delirium) delirium diagnostic tools in neurological settings.
Unlike binary delirium instruments such as the CAM (positive/negative), the MDAS produces a continuous severity score (0–30) that is its primary clinical strength. Use the MDAS total to quantify treatment response: a patient whose MDAS decreases from 18 to 9 after 48 hours of antipsychotic therapy has demonstrated a 50% reduction in delirium severity — clinically meaningful data that cannot be captured by a binary screen. Document serial MDAS scores with timestamps to build a delirium severity trajectory chart for each patient.
A cutoff of 13 or above is the most frequently cited MDAS threshold for delirium confirmation, derived from the original validation studies in oncology patients. However, some validation studies in other populations (post-operative, geriatric medical) have found optimal thresholds as low as 7 or as high as 20 depending on the reference standard and population. In oncology and palliative care — the MDAS's primary validation context — a threshold of 13 is most appropriate. In other settings, apply clinical judgment and supplement MDAS with diagnostic tools validated in that population.
Clinicians rating the MDAS may unconsciously allow the overall impression of a severely agitated or very confused patient to inflate scores on all 10 domains (halo effect), or conversely, allow a calm appearing patient to deflate scores that should be positive. Rate each of the 10 MDAS domains independently based on specific observable findings relevant to that domain. For example, a patient can have significant disorientation (high domain 2 score) while remaining calm (low psychomotor domain score) — both should be rated as observed.
Domain 4 (digit span capacity) requires the examiner to administer sequences of digits forward at a rate of one digit per second and assess whether the patient can correctly recall them. Standardized digit span sequences used in the MDAS should be memorized or available on a reference card to ensure consistency across examiners and assessments. Inconsistent administration speed or sequence selection can confound serial MDAS comparisons. The digit span domain is particularly sensitive to attention deficits — the core cognitive disturbance in delirium.
In patients with advanced cancer and terminal illness, rapidly rising MDAS scores (sustained increases of 5 or more points over 24–48 hours) are associated with shortened survival time in several oncology studies. This prognostic significance should be communicated to palliative care teams and incorporated into family communication about disease trajectory and end-of-life planning, but should not be used deterministically — some terminal delirium episodes are fully or partially reversible with treatment of the underlying precipitant.
In oncology and palliative care wards, combining nurse-administered [Nu-DESC](/tools/nu-desc) shift monitoring with physician-administered MDAS assessments provides a robust delirium monitoring framework. Nu-DESC captures continuous delirium behavioral observations across all nursing shifts; MDAS quantifies delirium severity for treatment response documentation and clinical decision-making. The two tools are complementary: a persistently elevated Nu-DESC with a high MDAS score indicates established delirium requiring active management, while a declining MDAS despite intermittently elevated Nu-DESC suggests partial treatment response with ongoing breakthrough delirium episodes.
Patients with MDAS scores in the 7–12 range have subsyndromal delirium — delirium features that are clinically significant but do not meet full MDAS threshold of 13. Subsyndromal delirium is associated with elevated risks of progression to full delirium, prolonged hospitalization, and adverse outcomes comparable to full delirium. Rather than ignoring scores in this range, use them to intensify non-pharmacological prevention measures: sleep hygiene optimization, reorientation, early mobilization, sensory aid use, medication review, and correction of metabolic abnormalities.
MDAS is a widely studied delirium severity instrument with validation in medical and oncology populations.
Higher MDAS scores indicate greater delirium symptom burden and support closer diagnostic and management review.
Use when clinicians need a structured delirium-severity metric for baseline and follow-up monitoring.
Cutoffs vary across populations; sedation, severe dementia, and communication barriers can affect scoring.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · trust-baseline
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A brief 5-item nursing delirium screen (0-10) commonly using >=2 as a positive threshold.
OpenGeriatricsScreen for delirium using the CAM (Confusion Assessment Method). Gold standard with ~94% sensitivity and ~89% specificity. Requires acute onset + inattention, plus disorganized thinking or altered consciousness.
OpenEmergencyScreen ICU patients for delirium using the CAM-ICU algorithm (acute/fluctuating change, inattention, consciousness, disorganized thinking).
OpenGeriatricsRapid delirium screening tool scored 0-12; scores of 4 or more suggest possible delirium.
Open