Disorganised thought processes

Note: Patient must be able to speak or write to assess thought processes.

Definition: Disorganised thinking, as indicated by rambling, irrelevant or incoherent speech.

How to assess:

This can be assessed through standard orientation questions. For example, "Can you tell me what year it is? What is today's date? About what time is it now? Where are you now?" There is disorientation to time and place but rarely to person.

To test if someone is displaying disorganised thought processes determine if the responses to questions are tangential, rambling, incoherent or irrelevant. The person will find the questions difficult to answer, be evasive with responses, or lose the thread of the conversation. There will be illogical flow of ideas and possible paranoid statements. A person may also have disordered perception (e.g. illusions, hallucinations). For example does the person answer a different question to the one you have asked? Are they noticing or talking about things which are not relevant to the question/s you have asked or is the flow of ideas illogical.

NB: Someone who has dementia may display disorganized thinking at baseline

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.