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To clarify the delirium phenotype, we present a close reading of past and current sets of delirium diagnostic criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We first differentiate the delirium syndrome (<jats:italic>i.e.<\/jats:italic>, features evaluated at bedside) from additional criteria required for diagnosis. Next, we align related features across diagnostic systems and examine them in context to determine intent. Where criteria are ambiguous, we review common delirium instruments to illustrate how they have been interpreted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>An acute disturbance in attention is universally attested across diagnostic systems. A second core feature denotes confusion and has been included across systems as disturbance in awareness, impaired consciousness, and thought disorganization. This feature may be better understood as a disturbance in thought clarity and operationalized in terms of neuropsychological domains thereby clearly linking it to global neurocognitive disturbance. Altered level of activity describes a third core feature, including motor and sleep\/wake cycle disturbances. Excluding stupor (wherein mental content cannot be assessed due to reduced arousal) from delirium, as in DSM\u20105\u2010TR, is appropriate for a psychiatric diagnosis, but the brain injury exclusion in ICD\u201011 is unjustified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The delirium phenotype involves a disturbance in attention, qualitative thought clarity, and quantitative activity level, including in relation to expected sleep\/wake cycles. Future diagnostic systems should include a severity threshold and specify that delirium diagnosis refers to a 24\u2010h period.<\/jats:p><\/jats:sec>","DOI":"10.1002\/gps.6046","type":"journal-article","created":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T06:29:58Z","timestamp":1703572198000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The phenotype of delirium based on a close reading of diagnostic criteria"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0981-7522","authenticated-orcid":false,"given":"Mark A.","family":"Oldham","sequence":"first","affiliation":[{"name":"Department of Psychiatry University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam T.","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Neurology Department of Obstetrics and Gynecology University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.neuropsych.20120316"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaclp.2022.11.002"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2021.11.007"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010008\u20101177\u20106"},{"key":"e_1_2_8_6_1","unstructured":"Network for Investigation of Delirium: Unifying Scientists (NIDUS).Measurement and Harmonization Core;2022. 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