86. Delirium Flashcards
DSM-5 Diagnostic Criteria for Delirium (A-D)
A. disturbance in attention + awareness
B. short period of time, fluctuates in severity
C. disturbance in cognition (memory/language/hallucination)
D. evidence that disturbance is caused by direct physiological consequence of another general medical condition
What clinical domains are affected by delirium (5)? Briefly describe the pathophys for delirium.
- Impaired conscious/attention
- Disturbance of cognition
- Psychomotor disturbance (hyper/hypoactivity)
- Circadian Rhythm disruption
- Emotional Dysregulation
1+ are affected
Pathophys: precipitants impact major domains = NT dysregulation or network disconnectivity = acute brain failure
Describe the morbidity/mortality of delirium.
What are the 3 cognitive trajectories of delirium?
Higher risk of mortality with delirium in general illness
Higher morbidity due to more hospital days, more chronic cognitive syndromes, higher cost, PTSD
- Complete Recovery
- Incomplete Recovery - most pts have ongoing impairment
- No recovery (chronic impairment)
What are the top 3 predisposing factors to delirium?
What are the 2 key precipitating factors?
Age: more risk
Cognition: more dementia = more risk
Frailty: more risk
- Systemic Brain insults
- Toxins: Polypharmacy (>3 meds per pt - anticholinergics, benzos, opioids, CS)
What are the 4 differences between dementia and delirium?
What is the triad of DLB?
Dementia: slow, over mo-yrs, good attention, bad memory, word finding problems
Delirium: rapid, over hrs-wks, bad attention, ok memory, incoherent speech
DLB: 1. Fluctuating cognition with changes in alertness/attention
- Recurrent visual hallucinations
- Parkinsonism
What is the tx plan for delirium?
First line: Address underlying cause
Supportive: IV fluids, sleep-wake intervention, orientation aids, early ambulation
Antipsychotics: haloperidol (less impairment, shorter delirium) Alpha2 agonists (decrease days of delirium)
