Confusion Flashcards
Components of Hx to diagnose cognitive impairment
- Onset (when + how rapid)
- Course ( fluctuating/progressive decline)
- Associated features (other illness, functional loss e.g. loss of mobility/reduced self care/new incontinence
Key features of delirium
- Disturbed consciousness (hypo/hyper active or mixed)
- Change in cognition (memory/perception/language/hallucinations)
- Acute onset or fluctuant
Other features of delirium
- Disturbance of sleep wake cycle
- Disturbed psychomotor behaviour
- Emotional disturbance
- Delusions
How to diagnose delirium
4 AT (questionnaire)
A 4AT score of 4 above, 1-3 and 0 mean what
- 4 and above = Possible delirium +/- cognitive impairment
- 1-3 = Possible cognitive impairment
- 0 = Delirium or severe cognitive impairment unlikely
When is a 4AT score essentially useless
When unable to comment on acute change or fluctuating course of alertness or cognition
As delirium may be present in that case even if 4AT score = 0
Management of delirium
-Stop bad drugs
Anticholinergics
Sedatives
-Drug treatment is usually not required, unless a danger to themselves or others or distress which can not be settled in another way
What drug can be used to treat delirium
- Quetiapine orally 12.5mg
- Start low and go slow
Non-pharmacological treatment of delirium
- Re-orientate + reassure patient (use friends/family)
- Encourage early mobility + self care
- Correction of sensory impairment
- Normalise sleep-wake cycle
- Avoid catheters + venflons
- Ensure continuity of care (avoid frequent ward/room transfers)
5 types of dementia
- Alzheimer’s
- Vascular dementia
- Mixed Alzheimer’s/vascular
- Lewy body dementia
- Reversible causes
Describe Alzheimer’s
- Slow, insidious onset
- Loss of recent memory first
- Progressive functional decline
Risk factors for Alzheimer’s
- AGE
- Vascular risk factors
- Genetics
Describe vascular dementia
- Step-wise deterioration
- Executive dysfunction may predominate
- Associated with gait problems ofter
Risk factors for vascular dementia
- Type 2 DM
- AF
- IHD
- PVD
Describe Lewy body dementia
- Link with Parkinson’s disease (2/3 will have movement problems)
- Often very fluctuant
- Hallucinations and falls common
Probably underdiagnosed
