Clinical: Altered Mental Status

Question 1

How to determine if altered mental status is chronic or acute?

Answer 1

Acute:

• days to weeks
• sudden
• impaired cognition
• *reduced attention

Chronic:

• weeks to months
• insidious
• impaired cognition
• *NO reduced attention
• usually Neurodegenerative

Question 2

Delirium

Answer 2

A subset of acute mental confusion
- ARE NOT SYNONYMOUS

Is usually 2nd to a non-CNS disease process (acute confusion is usually 2nd to CNS diseases)

A disturbance in attention and awareness w/ additional disturbances in cognition
- develops quickly and fluctuates in severity during the day

Usually only diagnosed when there is no better alternative explanation
- usually evidence from Hx/PE/labs that the disturbance is 2nd to a non-CNS condition (there has to be a non-CNS condition present)

*common in hospitalized patients

Question 3

What are alarm features for acute altered mental status

Answer 3

Persistent course that is immune to treatment

CNS signs/symptoms are present

Trauma, anticoagulation or CVA risks are present