Delirium

Question 1

What is delirium?

Answer 1

Disturbance in attention
Change in cognition
Develops over a short period and fluctuates

Question 2

What percentage of older people experience delirium prior or during hospital admission?

Answer 2

15-60%

Question 3

What is the onset of delirium?

Answer 3

Sudden (hours/days)

Question 4

What is the course of delirium?

Answer 4

Short/fluctuating

Question 5

What is the duration of delirium?

Answer 5

Hours to less than a month

Question 6

How does hyperactive delirium present?

Answer 6

Agitation
Restless
Hyperactive

Question 7

How does hypoactive delirium present?

Answer 7

Sleepy

Slow

Question 8

What are some features of delirium?

Answer 8

Impaired attention
Fluctuating alertness
Fluctuating emotions
Disorganised thinking
Distorted perception (hallucinations, illusions, delusions)

Question 9

What is the pathophysiology of delirium?

Answer 9

Not well understood
Variable derangement of multiple neurotransmitters (ACh)
Direct toxic insults to brain

Question 10

What are pre-disposing factors?

Answer 10

Advanced age
Pre-existing dementia
Co-morbidity
Post-operative period
Terminal illness
Sensory impairement
Polypharmacy
Depression
Alcohol dependency
Malnutrition

Question 11

What are precipitating factors?

Answer 11

Opiates + sedatives
Hypoxia
Low glucose
Dehydration
Alcohol
Infection (chest)
UTIs
Environmental
Catheters (foreign objects)
Systemic upset
MI
Hip fractures
Urinary retention
Constipation
Trimethoprim

Question 12

What are the hallmark signs of delirium?

Answer 12

Acute and fluctuating
Inattention
Altered level of consciousness
Disorganised thinking

Question 13

Which delirium is easier to diagnose?

Answer 13

Hyperactive

Hypoactive has twice the mortality rate because of this

Question 14

What assessments help diagnose delirium?

Answer 14

4AT

CAMS

Question 15

What does 4AT comprise of?

Answer 15

Alertness
AMT4
Attention
Acute change or fluctuating course

Question 16

What score indicates delirium using 4AT?

Answer 16

> 4 think delirium

The lower the score the less likely delirium is

Question 17

What are the 4 features of CAM?

Answer 17

Acute onset and fluctuating course
Inattention
Disorganised thinking
Altered level of consciousness

Question 18

How is delirium managed?

Answer 18

Identify and treat precipitants
Supportive measures (environment, orientation, sleep)
Assess capacity
Medication

Question 19

How is delirium treated?

Answer 19

Check hydration
Stop nephrotoxic drugs
Optimise BP and perfusion
Look for intrinsic renal disease
Review

Question 20

Which two drugs should never be prescribed together?

Answer 20

Trimethoprim and Haloperidol!

Question 21

What side effect does co-codamol cause that contributes to delirium?

Answer 21

Constipation

Question 22

What side effect does the anti-muscarinic drug tolterodine cause that contributes to delirium?

Answer 22

Confusion

Question 23

What medication can be used if symptoms do not improve with non-pharmacological interventions?

Answer 23

Haloperidol
Quetiapine
Benzodiazepines

Question 24

Which delirium drug should be avoided in Parkinson’s disease?

Answer 24

Haloperidol

Question 25

Which drug can worsen delirium?

Answer 25

Lorazepam