Chapter 8 Pt 1 Flashcards
neurocognitive disorders comprise a group of conditions defined by what
decline from a previous level of cognitive functioning
what are the six cognitive domains that may be affected
Complex Attention Executive Function Learning and Memory Language Perceptual-motor skills social cognition (interaction
the DSM-V decides neurocognitive disorders into what 3 main categories
delirium
mild NCDs
Major NCDs
delirium is considered a medical what
EMERGENCY
may be the only early manifestation of a serious illness
what is the ICU triad
delirium
pain
agitation
delirium is REVERSIBLE but it can potentially advance to what
Coma
seizures
death
delirium is associated with what kind of mortality
HIGH
up to 40% of individuals die within one year of diagnosis
as many as what percent of medically admitted patients develop delirium
50%
what are some alternative terms for delirium
toxic or metabolic encephalopathy acute organic brain syndrome acute confusional state acute toxic psychosis ICU psychosis
what are common causes od medication induced delirium
TCAs Anticholinergics Benzos Nonbenzo hypnotics (Z drugs) cotricosteroids H2 blockers Meperidine
what are some risk factors for delirium
poly pharmacy, including the use of psychotropic medications (especially benzos and anticholinergic) advanced age preexisting cognitive impairment or depression prior history of delirium alcohol use severe or terminal illness multiple medical comorbidities impaired mobility hearing or vision impairment malnutrition male gender pain
the DSM-5 recognizes what 5 broad categories of delirium
substance intoxication delirium substance withdrawal delirium medication-induced delirium delirium due to another medical condition delirium due to multiple etiologies
what are the clinical manifestations of delirium
primarily disorder of ATTENTION and AWARENESS (i.e. ORIENTATION)
cognitive defects DEVELOP ACUTELY over hours to days
symptoms FLUCTUATE throughout the course of the day, typically WORSENING AT NIGHT
deficits in RECENT MEMORY, language abnormalities, or perceptual disturbances (usually VISUAL illusions or hallucinations)
circadian rhythm disruption and emotional symptoms
what are the three types of delirium based on psychomotor activity
mixed type (most common)
hypoactive ("quiet") type
hater active ("ICU psychosis") typewhat is seen in the mixed type of delirium
MOST COMMON
psychomotor activity may remain stable at baseline or fluctuate rapidly between hyperactivity and hypoactiviity
what is seen in the hypoactive “quite” type of delirium
decreased psychomotor activity, ranging form drowsiness to lethargy to stupor
more likely to go UNDETECTED
more common in elderly
what is seen in hyperactive “icu psychosis” type of delirium
manifests with AGITATION, mood lability, and uncooperativeness
less common, more easily identifiable due to its disruptiveness
more common in DRUG WITHDRAWAL or TOXICITY
how does delirium present on EEG
DIFFUSE BACKGROUND SLOWING
exception is DELIRIUM TREMENS which is associated with FAST ACTIVITY
EEG lacks sensitivity and specificity for delirium diagnosis but is useful for what
ruling out non-convulsive seizures
delirium + hemiparesis or other focal neurological signs and symptoms is likely due to what
CVA or MASS LESION
head CT/Brain MRI is diagnostic testing
delirium + elevated blood pressure + papilledema is likely due to what
Hypertensive Encephalopathy
head CT/Brain MRI is diagnostic testing
delirium + dilated pupils + tachycardia is likely due to what
drug intoxication
UDS is diagnostic test of choice
delirium + fever + nuchal rigidity + photophobia is likely due to what
MENINGITIS
LP is diagnostic test
delirium + tachacardia + tremor + thyromegaly is likely due to what
thyrotoxicosis
Free T3, T3, and TSH are diagnostic tests
what are the most common precipitants of delirium in children
febrile illness
medications
complete recovery from delirium typically occurs when
in most hospitalized patients about 1 WEEK
some cognitive deficits can persist for months or even remain indefinitely
