Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Geriatrics > Confusion > Flashcards

Confusion Flashcards

1
Q

What are the difficulties in trying to define confusion

A 
Can be a brain problem
Deafness
Asking someone to do something that is too difficult
Culture differences
Etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is it better to think about rather than confusion?

A

Cognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the six neurocognitive domains and subdomains in DSM5?

A 
Complex attention 
Perceptual-motor function
Language function 
Executive function 
Learning/memory
Social cognition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is involved in complex attention?

A

Sustained attention
Divided attention
Selective attention
Processing speed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is involved in perceptual-motor function?

A

Visual perception
Visuoconstructional reasoning
Perceptual-motor co-ordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is involved in language function?

A 
Object naming
Word finding
Fluency
Grammar and syntax
Receptive language
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is involved in executive function?

A 
Planning
Decision making
Working memory 
Responding to feedback 
Inhibition 
Flexibility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is involved in learning and memory?

A 
Free recall
Cued recall
Recognition memory 
Semantic and autobiographical long term memory 
Implicit learning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is involved in social cognition?

A

Recognition of emotions
Theory of mind
Insight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is assessing cognition of value?

A

?Relevant to current medical problems
Associated with increased risk of death/increased length of stay/discharge to care home
May need to alter communication/involve family
Decisions re capacity
May alter appropriateness of tests/Ix/Rx
May be able to improve it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the reversible cause of confusion?

A

Delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is key in diagnosing cause of the cognitive impaired?

A 
History 
Collateral history (GP, family etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do you want to know from the history of a confused person?

A

Onset - when, how rapid
Course - fluctuating, progressive decline
Associated features, e.g. other illness or functional loss (e.g. reduced mobility or self-care, new incontinence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the key features of delirium?

A

Disturbance consciousness
Changes in cognition
Acute onset & fluctuant
Generally worse at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the two kinds of delirium?

A

Hyperactive delirium
Hypoactive delirium
Often a mix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is hyperactive delirium?

A

Restless, exploring environment, agitated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is hypoactive delirium?

A

Abnormally sleepy
(Lethargic, sedated, stupor)
(sometimes hard to stop)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some other common features of delirium?

A

Disturbed sleep wake cycle
Disturbed psychomotor behaviour (more likely to fall)
Emotional disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Who does delirium tend to affect?

A

Those at extremes of age

Those who are frail or have cognitive frailty (e.g. dementia, parkinsons, MS etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why is the proposed mechanism for delirium?

A

Maladaptive pro-inflammatory response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some common precipitants of delirium?

A 
Infection, e.g. UTI 
Dehydration 
Biochemical disturbance 
Pain
Drugs
Constipation/urinary retention 
Hypoxia
Alcohol/drug withdrawal 
Sleep disturbance 
Brain injury, e.g. stroke, tumour, bleed
Changes in environment and social set up 
Often multiple triggers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What kind of changes in cognition can occur with delirium?

A

Memory issues
Perceptual or language issues
Illusions
Hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the most common biochemical disturbances causing delirium?

A

High or low sodium and high calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How can drugs cause delirium?

A

Either by acting on the brain directly, or by leading to an electrolyte disturbance, e.g. ACEi causing AKI

25
Q

What % of in patients get delirium?

A

20-30%

26
Q

What is the commonest complication of hospitalisation?

A

Delirium

27
Q

What are the consequences of delirium?

A

Increased risk of death
Longer length of stay
Increased rates of institutionalisation
Persistent functional decline

28
Q

How do you diagnose delirium?

A

4AT

Hx

29
Q

Who gets a 4AT?

A

Everyone over age 65y in hospital

30
Q

What are the four domains of a 4AT?

A

Alertness
AMT4 (age, DoB, place)
Attention
Acute change or fluctuating course

31
Q

What does a 4AT of 4 mean?

A

Possible delirium -/+ cognitive impairment

32
Q

What does a 4AT of 1-3 mean?

A

Possible cognitive impairment

33
Q

What does a 4AT of 0 mean?

A

Delirium or severe cognitive impairment unlikely

34
Q

How do you manage delirium?

A

Treat the cause (full Hx, Ex)

35
Q

What tool is used to check for delirium triggers?

A

TIME bundle

Must be started within 2 hours

36
Q

What is involved in the non-pharmacological treatment of delirium?

A 
Re-orientate and re-assure patient 
Encourage early mobility and self care
Correction of sensory impairment
Normalise sleep wake cycle (natural light)
Ensure continuity of care 
Avoid urinary catheterisation/venflons
37
Q

What is involved in the pharmacological management of delirium?

A

Stop bad drugs
Drug treatment not usually necessary, if it is must be done by senior
If danger to themselves/distress that can not otherwise be settled give 12.5mg quetiapine
DO NOT want to sedate (injury risk)

38
Q

What drugs are bad in delirium and you would stop?

A

Anticholingerics
Sedatives
ACEi and NSAIDs if biochemical disturbance

39
Q

Define dementia

A

Acquired decline in memory and other cognitive functions in an alert person sufficiently severe to cause functional impairment and present from more than 6 months

40
Q

Give examples of functional impairment

A

Forgetting to take tablets
Unable to use phone
Difficult washing and dressing

41
Q

State the 5 major dementias

A 
Alzheimer's
Vascular dementia
Mixed Alzheimer's/vascular
Dementia with Lewy bodies
Reversible causes
42
Q

Describe the onset of Alzheimer’s

A

Slow, insidious
Loss of recent memory first
Progressive functional decline

43
Q

What are the risk factors for Alzheimer’s?

A

Age (biggest RF)
Vascular risk factors
Genetics

44
Q

Describe the typical characteristics of vascular dementia

A

Step wise deterioration
Executive dysfunction may predominate rather than memory impairment (e.g. problem solving and planning affected)
Often associated with gait problems

45
Q

What risk factors are associated with vascular dementia?

A

Vascular (e.g. type 2 DM, AF, IHD, PVD)

46
Q

What are the characteristics of dementia with Lewy Bodies?

A

May have parkinsonism
Often very fluctuant
Hallucinations common
Falls common

47
Q

What symptoms are included in parkinsonism?

A

Gait issues
Slow movements
Rigidity

48
Q

When is fronto-temporal dementia often diagnosed?

A

At earlier age

49
Q

What are the typical characteristics of fronto-temporal dementia?

A

Behaviour change, e.g. aggression
Language difficulties, may present like stroke/tumour/become aphasic
Usually lack insight

50
Q

What tools can be used to help diagnose dementia?

A

MMSE, MOCA

51
Q

What are the issues with the MMSE and MOCA?

A

Culturally/generationally/intellectually specific
May be falsely reassuring

Remember hx is key, do not use these tools to diagnose

52
Q

What is involved in the management of dementia?

A

Support for person and carers
Cognitive stimulation
Exercise
Environmental design (e.g. signs in picture form)
Avoiding changes in environment/social support
Advanced care planning
Drugs

53
Q

What drugs can be used to manage dementia?

A

Cholinesterase inhibitors (mainly used in Alzheimer’s)
Galantamine licensed in mixed dementia
Rivastigmine in dementia with Lewy bodies

Antipsychotics (avoid if possible)

54
Q

A demented patient on antipsychotics is at increased risk of what?

A

CV death

55
Q

State some reversible causes of dementia

A 
Hypothyroidism/hyperthyroidism
B12 deficiency 
Intracranial bleeds/tumours
Hypercalcaemia
Normal pressure hydrocephalus
Depression
56
Q

What drug exacerbates lewy body dementia?

A

Metoclompramide (lowers dopamine levels)

57
Q

What domains are tested in the MMSE?

A 
Orientation 
Registration 
Attention and calculation 
Recall
Language
58
Q

What domains are assessed in the MOCA?

A 
Visuospatial/executive
Naming
Memory
Attention
 Language
Abstraction 
Delayed recall
Orientation

Geriatrics (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions