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DRS-R-98 (Delirium Rating Scale)
DRS-R-98: Rate severity of symptoms over the past 24 hours. Items 1-13 measure severity. Items 14-16 aid diagnostic classification. Higher scores = greater severity.
Rate each domain
1. Sleep-Wake Cycle Disturbance
2. Perceptual Disturbances and Hallucinations
3. Delusions
4. Lability of Affect
5. Language Abnormalities
6. Thought Process Abnormalities
7. Motor Agitation
8. Motor Retardation
9. Orientation
10. Attention
11. Short-Term Memory
12. Long-Term Memory
13. Visuospatial Ability
14. Temporal onset of symptoms
Diagnostic Item
15. Fluctuation of symptom severity
Diagnostic Item
16. Physical disorder
Diagnostic Item
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Quantifying the severity of delirium symptoms in clinical and research settings.
Monitoring response to delirium interventions or pharmacotherapy.
Distinguishing delirium from dementia, depression, or schizophrenia based on symptom profile.
Unlike the CAM or 4AT which are binary screening/diagnostic tools, the DRS-R-98 provides a granular severity score (0-39) covering a broad phenomenological spectrum of delirium. It is the gold standard for measuring delirium severity.
Section 2
Formula & Logic
Scoring
16 items total: 13 severity items + 3 diagnostic items.
Severity scale (0–39): Evaluates symptom severity over the past 24 hours.
Total scale (0–46): Includes diagnostic items (onset, fluctuation, physical disorder).
Score > 15 (Severity) or > 17 (Total) strongly suggests delirium.
Hallucinations, delusions, thought process abnormalities
Motor & Sleep
Motor retardation, motor agitation, sleep-wake cycle disturbance
Language
Language abnormalities, thought disorder
Section 3
Pearls/Pitfalls
Subtyping Delirium
The detailed motor items on the DRS-R-98 allow for precise classification of delirium motor subtypes (hyperactive, hypoactive, or mixed), which have different prognostic implications and aetiologies.
Section 4
Next Steps
Management
Section 5
Evidence Appraisal
Primary Reference
Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium.
Trzepacz PT et al. • J Neuropsychiatry Clin Neurosci.. 2001;13(2):229-42. High inter-rater reliability, validity, and ability to distinguish delirium from dementia.
Section 6
Origins
Paula Trzepacz
Developed by Paula Trzepacz and colleagues. The original DRS (1988) was revised in 1998 to capture a wider range of symptoms (e.g., separating language from thought process, and evaluating motor subtypes independently) reflecting an updated understanding of delirium phenomenology.
