Collateral history for confusion

Question 1

Features of the confusion/memory which should be clarified?

Answer 1

Onset- acute or chronic?

Course- gradual deterioration, stepwise, fluctuating?

Question 2

Cognitive symptoms to ask about (5)

Answer 2

Memory loss
Loss of orientation
Reading/writing/numbers
Deficits in planning
Attention

Question 3

Other symptoms (5)

Answer 3

Agitation/aggression
Hallucinations
Mood disturbance
Behavioural e.g. wandering, disinhibition
Parkinsonian features

Question 4

Differential diagnosis for confusion in an elderly person (7)

Answer 4

Delirium
LB dementia
AD dementia
Parkinsons disease
Vascular dementia
Frontotemporal dementia
Depression
Brain bleed (subdural, extradural, intraparenchymal)

Question 5

Important aspects of past medical history and rationale (5)

Answer 5

Vascular risk factors (vascular dementia)
Head injury (bleeding risk)
Infection (delirium)
Parkinsons (impaired cognition in late stage)
Psychiatric history

Question 6

Aspects of drug history to ask about (6)

Answer 6

Any recently started 
Over the counter
Allergies
Any regular prescribed
Drug compliance
WARFARIN!

Question 7

Aspects of social history to ask about (6)

Answer 7

Support at home- friends, family
Activities of daily living- who performs them?
Smoking and alcohol
Diet- b12/folate/thiamine deficiency?
RISK- to self (e.g. wandering, leaving gas on, self neglect) or to others (aggression)
Ideas concerns and expectations from the consultation

Question 8

Common causes of delirium (7)

Answer 8

Infection e.g. UTI, pneumonia, sepsis
Constipation
Urinary retention
Pain
Metabolic/endocrine
Medications
Neuro- SOL, raised ICP, bleed