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Specialities - Medicine of Old Age > Acute & chronic confusion in old age > Flashcards

Acute & chronic confusion in old age Flashcards

1
Q

What are important features to consider when taking a history of someone with cognitive impairment?

A

Onset - When and how quickly?

Course - Has the decline be fluctuating or steadily declining

Associated features - Reduced mobility, reduced self-care, new incontinence

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2
Q

What are the commonest causes of cognitive impairment?

A

Delirium

Dementia

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3
Q

What are the key features of delirium?

A

1 - Acute onset and fluctuant

2 - Change in cognition

3 - Disturbed consciousness

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4
Q

Apart from the key features, what are some of the other common features of delirium?

A

1 - Disturbed sleep wake cycle

2 - Disturbed psychomotor behaviour

3 - Emotional disturbance

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5
Q

What are the subtypes of delirium?

A

Hyperactive

Hypoactive

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6
Q

What changes in cognition can someone with delirium display?

A

Memory

Perceptual

Language

Hallucinations

Illusions

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7
Q

What can precipitate delirium?

A

1 - Infection

2 - Dehydration

3 - Drugs

4 - Alcohol withdrawal

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8
Q

How is delirium diagnosed?

A

4AT score

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9
Q

What questions might you ask a patient you suspect of having delirium or cognitive impairment?

A
  • What is your name and address?
  • What is your age? D.O.B? Where are you? Current year?
  • Tell me the months of the year backwards
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10
Q

What are the non-pharmacological treatments for delirium?

A

1 - Re-orientate and re-assure

2 - Encourage early mobility

3 - Normalise sleep-wake cycle

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11
Q

When delirium has been diagnosed which drugs should be stopped?

A

1 - Anticholinergics

2 - Sedatives

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12
Q

Which drug can be used to treat delirium where the patient is a danger to themselves or extreme distress?

A

Quetiapine

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13
Q

What is the definition of dementia?

A

Decline in cognitive functions that are sufficient to cause functional impairment and are present for > 6 months

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14
Q

What are some common signs of dementia?

A

1 - Forgetting to take tablets

2 - Unable to use phone

3 - Difficulty washing/dressing

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15
Q

What are the 3 main types of dementia?

A

Alzheimers

Vascular

Dementia with Lewy bodies

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16
Q

What are the characteristic features of alzheimers?

A

1 - Slow, insidious onset

2 - Loss of recent memories first

3 - Progressive functional decline

17
Q

What are the risk factors for alzheimers?

A

1 - Age

2 - Vascular risk factors

3 - Genetics

18
Q

What are the common features of vascular dementia?

A

1 - Step-wise deterioration

2 - Executive dysfunction

3 - Gait problems

19
Q

What vascular risk factors are often present in patients with vascular dementia?

A

Type 2 DM

AF

IHD

20
Q

What are the common features of dementia with lewy bodies?

A

1 - Parkinsonism

2 - Fluctuant

3 - Hallucinations

4 - Falls

21
Q

What are the common features of a fronto-temporal dementia?

A

1 - Early age onset

2 - Behavioural change

3 - Language difficulties

4 - Lack of insight

22
Q

What are some methods used to diagnose dementia?

A

MMSE

MOCA

23
Q

What are some non-pharmacological treatment options for dementia?

A

1 - Cognitive stimulation

2 - Exercise

3 - Avoid changes in environment

24
Q

What pharmacological treatments can be used for dementia?

A

Cholinesterase inhibitors

25
Q

82 year old man

Brought to A&E as found walking down street with his pyjamas on

D/w family

Increasingly forgetful over last year

Burns pans

Frequent phone calls to daughter

Accusing carers of stealing

Gradual decline over last 2 years

No significant PMH

Bloods - normal

What is the diagnosis?

A

Alzheimers

26
Q

89 years old

Normally lives independently

“off legs, confused”

Febrile, “smells of urine”, looks dry

DH

Aspirin, furosemide, ramipril, codydramol, amitriptyline

Normally independent

Still travelling the world

No memory problems

Fall and subsequent sore knee recently

GP started a new tablet

Bloods

CRP 15, WCC 8

Urea 12, creat 65

What is the diagnosis?

A

Delirium

27
Q

Very old man

Lives alone in isolated house

No family

Fall with long lie

PMH: BPH, hypertension, AF

Drugs: Codydramol, Thyroxine, tamsulosin, Omeprazole, Metoclopramide, Ramipril, amlodipine

–Not right for a year

–Good days and bad days

–Shouting at people who aren’t there

–Lots of falls

–Slowed down last few months

What is the diagnosis?

A

Dementia with Lewy bodies

Specialities - Medicine of Old Age (6 decks)

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