Confusion (conditions from sofia)

Question 1

What is delirium?

Answer 1

An acute, fluctuating level of consciousness

Question 2

What tool is used for the conditions needed for the diagnosis of delirium?

Answer 2

DSM-5

Question 3

What are the 4 conditions that need to be met for delirium to be diagnosed?

Answer 3

1) Change in cognition
2) Disturbance in attention
3) Delirium has risen due to a suspected medical cause eg drug toxicity
4) Arose over a short time period eg days/hours

Question 4

What is a main way of differentiating delirium from dementia?

Answer 4

Delirium is a new change is consciousness that is acute and will arise over a short time period eg days or hours whereas dementia is degenerative and will progress over weeks/months

Question 5

Who is more at risk of delirium?

Answer 5

Hospitalised patients
Acutely unwell patients/ degenerating patients
Patients with cognitive impairment/dementia
Older patients eg over 65

Question 6

How is delirium diagnosed?

Answer 6

Clinically

Question 7

How is delirium managed

Answer 7

Treat the cause eg if drug toxicity, stop the drug
Usually it is short an temporary and will resolve
If a patient is a threat to themselves or others, de escalate by talking them down
If this doesn’t work and you feel medication is needed, use low dose haloperidol or antipsychotics

Question 8

What common infection can cause delirium/ confusion (especially in older people)?

Answer 8

Urinary tract infection

Question 9

Why are old people more susceptible to delirium from infections?

Answer 9

They are a lot more frail and their body is more susceptible to mental decline when they are unwell

Question 10

What are the 4 types of dementia?

Answer 10

Alzheimer’s
with Lewy bodies
Vascular
Frontotemporal

Question 11

What are typical symptoms of someone with Alzheimer’s?

Answer 11

Problems with memory
Nominal aphasia (forgets the name of objects/people)
Gets lost
Disorientated
Apathy (slowing of movements/lethargy etc)
Personality changes

Question 12

What are typical symptoms of someone with frontotemporal dementia?

Answer 12

Lack of regard for social conventions
Poor personal hygiene
Slovenly 
Agressive and stubborn behaviour
Acting childlike 
Impaired memory
Disorientation

Question 13

What are typical symptoms of someone with vascular dementia?

Answer 13

Similar to Alzheimer’s and often there is a lot of overlap between the 2
Cognitive impairment is more to do with difficulty planning things than memory

Question 14

What are typical symptoms of someone with dementia with Lewy bodies?

Answer 14

Visual hallucinations
Visuospatial impairments
REM sleep behavioural disorder
Parkinsonism

Question 15

What types of dementia are associated with Parkinsonism?

Answer 15

Dementia with Lewy bodies

Frontotemporal dementia

Question 16

How is dementia diagnosed?

Answer 16

Physical exam and history
Then do a cognitive test
Usually diagnosis is clinical

Question 17

How is dementia managed pharmacologically?

Answer 17

Acetylcholinesterase inhibitors eg donepazil
If moderate- severe add memantine
Antipsychotics or benzodiazipines if behavioural problems are serious and cause them to be at risk to themselves or others
Be careful as antipsychotics can worsen Parkinsonism

Question 18

Who is at risk of dementia?

Answer 18

Older people
Smokers
Obese people
Those with family history
Those with genetic predisposition