Carers, Delirium and Dementia Flashcards
What is a carer?
Person of any age who provides unpaid support to a partner, child, relative or friend who wouldn’t manage to live independently or whose health or wellbeing would deteriorate without this help
What may lead to a person needing a carer?
Frailty Disability Serious health condition Mental ill health Substance misuse
What sort of roles may a carer have to take on?
Organisation of persons life Understand medical background of patient Food prep Stress management Own job? Help move around house Take to appointments etc. Finances
What is delirium?
Delirium is a state of mental confusion that can happen if you become medically unwell. It starts suddenly and resolves once the cause has been managed
What are the core features of delirium?
Cognitive impairment
Rapid onset
Fluctuating severity
How common is delirium?
10% of patients presenting to ED that are >65yo
What are the types of delirium?
Hyperactive - detected, fall risk, agitated, incoherent speech, disorganised thoughts, delusions
Hypoactive - often mistaken for depression, missed, sluggish and drowsy, look withdrawn
Mixed
What can predispose a patient to delirium?
Advanced age Dementia Polypharmacy Functional impairment Sensory impairment Malnutrition Co-morbidities
What can precipitate delirium?
Acute illness - esp UTI, pneumonia, constipation
Drugs - opiates, anticholinergics, sedatives
Metabolic disturbance
Alcohol
Dehydration
How is delirium assessed?
Confusion Assessment Method
Suspect if feature 1, 2 and either 3/4
1 - Acute onset and fluctuating course
2 - Inattention
3 - Disorganized thinking
4 - Altered consciousness
How would you assess each part of the confusion assessment method?
Alertness - asleep, normal etc.
AMT4 - age, DOB, current location, current year
Attention - months of year backwards
Acute change/fluctuating course
What investigations would you request for delirium?
CXR
Bloods - FBC, U&E, LFT, CRP etc.
Urine dip
How is delirium prevented and treated?
Minimise environmental disruption Good nursing care Medication review Orientation clock Lighting/side room
What should be done if a patient with delirium is having behavioural disturbances?
Non pharma first Consider DOLS (deprivation of liberty safeguard) Not physical restraint Lorazepam and haloperidol - low dose
What is the prognosis for delirium?
Increased mortality at 6 months
Increased hospital stay
Accelerated cognitive decline in dementia
What is the ICD10 definition of dementia?
Syndrome due to disease of the brain, usually chronic or progressive in nature.
Disturbance of multiple higher cortical functions including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement
Consciousness is not clouded.
Impairment of cognitive function accompanied by deterioration in emotional control, social behaviour or motivation
What is mild cognitive impairment?
Evidence of objective cognitive impairment but not severe enough to be classified as dementia
10-15% conversion to dementia per year
What are the main cognitive functions affected by dementia?
Complex attention
Executive ability - planning, decision making etc.
Learning and memory
Language
Visuoconstuctional and perceptual motor ability
Social cognition
What are the common causes of dementia?
Alzheimer’s
Vascular
Lewy body
Frontotemporal (pick’s disease)
Others - Alcohol, Huntington’s, HIV associated. MSA, PSP, Prion disease, MS etc.
What are the main risk factors for dementia?
Female > Male
Education, occupation, socioeconomic status
Genetics - APOE e4 allele
Smoking, alcohol, obesity, cholesterol, HTN, DM, cerebrovascular disease
Psychosocial factors, physical activity, depression
What is assessed in a history for dementia?
Timeline Collateral history important Symptoms - memory, executive function, language, insight, hallucinations etc. Driving? Support? Recent changes/bereavement? Risks? Comorbidities? Self care?
What is in the clinical cognitive assessment for dementia?
Orientation and attention - alertness and cooperation, time, place, who, serial 7’s, WORLD backwards, digit span, months of year backwards
Memory - episodic, semantic, working
Language - Name objects, comprehension, repetition, reading, writing, acalculia
Exec function - Letter and category fluency, impulsivity, personality change, reflexes
Apraxia - meaningless gestures, miming tasks
Visiospatial ability - Topographic disorientation, neglect, copying wire cube clock face and pentagons, prosopagnosia
What cognitive assessment scales are used for dementia?
MMSE AMT 6-CIT GP-COG MoCA ACEiii Formal neuropsychological assessment
What investigations are carried out for dementia?
Physical exam - look for cause/focal neurology
Bloods - FBC, U&E, B12 and folate, TFT, infections
ECG, CXR, EEG, MSU, LP, CT/MRI head
SPECT, FDG-PET, Amyloid PET
