Delirium

Question 1

What is delirium?

Answer 1

Clinical syndrome of disturbed consciousness, cognitive function or perception which has an acute onset and fluctuating course

Question 2

What poor prognostic factors are delirium linked to?

Answer 2

Mortality
Institutionalisation
Dementia

Question 3

What are the 2 types of dementia?

Answer 3

Hypoactive
Hyperactive

Question 4

What are some features of hypoactive delirium?

Answer 4

Withdrawn
Quiet
Sleepy

Question 5

What are some features of hyperactive delirium?

Answer 5

Restlessness
Agitated
Aggressive

Question 6

What is the name of the delirium that can be seen if someone has alcohol withdrawals?

Answer 6

Delirium tremens

Question 7

What is dementia?

Answer 7

Syndrome of chronic cognitive impairment

Question 8

What are some conditions/syndromes that can mimic delirium?

Answer 8

Dementia
Depression
Primary CNS pathology
Drug reactions

Question 9

What are some primary CNS pathologies that mimic delirium?

Answer 9

Infections
Blood
Stroke.

Question 10

What are some drug reactions that can mimic delirium?

Answer 10

Serotonin syndrome
Delirium tremens
Neuroleptic malignant syndrome

Question 11

What causes serotonin syndrome?

Answer 11

Excess serotonin:

Drugs like fluoxetine, citruline and combined with tramadol

Question 12

What causes neuroleptic malignant syndrome?

How does it present?

Answer 12

Parkinson’s mediations like L-dopa being missed

Leads to fever >40C

Question 13

How does serotonin syndrome present?

Answer 13

Hyperreflexia
Clonus
Seizures

Question 14

What is the believed pathophysiology behind delirium?

Answer 14

Systemic event happens leading to priming of Microglial cells and Astrocytes releasing inflammatory mediators

This leads to neurone damage in the brain and breakdown of the blood brain barrier

Question 15

What is the scoring system used to assess delirium?

Answer 15

4AT

Question 16

What is the scoring system used to assess delirium?

Answer 16

4AT

Question 17

What are the 4 A’s being tested?

Answer 17

Alertness
Abbreviated mental test
Attention
Acute changes or fluctuations

Question 18

How is alertness scored?

Answer 18

Normal = 0
Abnormal = 4

Question 19

What is the abbreviated mental test?

Answer 19

Ask for:
-age
-DOB
-Place
-Year

Correct = 0
1 error = 1
2 or more errors or untestable = 2

Question 20

How is attention tested?

Answer 20

Ask pateitn to say the months of the year backwards

7months correct = 0
1 error or refuses = 1
Untestable = 2

Question 21

How is an acute changes / fluctuation scored?

Answer 21

None = 0
Yes = 4

Question 22

What score suggests a high likelihood of delirium in the 4AT scoring test?

Answer 22

Score > 4

Question 23

How do you prevent delirium?

Answer 23

Hydration + nutrition
Hearing + visual aids
Optimise environment for night time sleep
Active reorientation
Mobilisation
Family interaction and cognitive stimulation

Question 24

What are some general classes of drugs that can put patients at increased risk of developing delirium?

Answer 24

Anticholinergic drugs

Question 25

What do medications need to assessed/scored by before being prescribed to patients at risk of developing delirium?

Answer 25

Anticholinergic burden

Question 26

What medication commonly causes delirium and falls in the elderly?

Answer 26

Amitryptoline

Question 27

What medication can you give to patients if they have low levels of acetylcholine?

Answer 27

Acetylcholinesterase inhibitors like pyridostigmine