Cognitive Disorders Flashcards
Define delirium.
waxing and waning change in a patient’s level of consciousness (can also be referred to as encephalopathy)
What percent of medically admitted patients exhibit delirium?
10-30%
What are some risk factors for the development of delirium?
advanced age preexisting brain damage prior history of delirium alcohol dependence diabetes cancer sensory impairment or blindness malnutrition male gender
What is the most common finding in delirium?
impairment in recent mamory
What are the diagnostic criteria for delirium?
- disturbance of consciousness w/ reduced ability to focus, sustain, or shift attention
- a change in cognitive or the development of a perceptual disturbance that is not better accounted for by a preexisting, established or evolving dementia
- the disturbance develops over a SHORT period of time (usually hours to days) and tends to fluctuate during the course of the day
If a patient has delerium with hemiparesis or other focal neurological symptoms, think…
CVA or mass lesion and get a brain CT or MRI
If a patient has delirium with elevated blood pressure and papilledema, think….
hypertensive encephalopathy and get a brain CT or MRI
If a patient has delirium with dilated pupils and tachycardia, think….
drug intoxication and get a UDS
If a patient has delirium with fever, nuchal rigidity and photophobia, think….
meningitis and get an LP
If a patient has deliurium, tachycardia, tremor and thyromegaly, think…..
thyrotoxicosis and get a TSH and free T4
Describe the treatment of delirium.
- rule out life-threatening causes
- treat the underlying condition
- supportive care with hydration and nutrition
- one-on-one nursing
- try to correct sleep cycle
- psychotropics for symptomatic relief (antipsychotics like haloperidol)
What psychotropic medication should be avoided in delirium?
benzodiazepines (unless it’s secondary to alcohol or benzo withdrawal) because they have been found to cause/prolong delirium
What is the prevalence of dementia at 60 years? 90 years?
1.5% at 60
40% at 90
(doubles every 5 years)
What is the most common type of dementia? Second most common?
- Alzheimer’s
2. Vascular
If there is a dementia with stepwise increase in severity and focal neurological signs, think….
multi-infarct dementia and get a CT/MRI
If there is dementia with rigidity and a resting tremor, thing…
parkinson disease or lewy body dementia