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Y4: Geriatric Medicine > Delirium > Flashcards

Delirium Flashcards

1
Q

Define delirium?

A
  • Acute, fluctuating change in mental status
  • With inattention, disorganised thinking and altered levels of consciousness
  • Life-threatening with high morbidity and mortality
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2
Q

What is the difference between mortality and morbidity?

A
  • Morbidity
    • Diseased state, disability or poor health
  • Mortality
    • Measure of number of deaths
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3
Q

Read these presentations of delirium

A
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4
Q

What characteristic parameter is used to diagnose delirium?

Name some key components of it

A
  • DSM-5 (2013)
    • Disturbance in attention and awareness
    • Develops over short time, flutctuates throughout the day
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5
Q

Name some differentials for delirium?

A
  • Dementia
  • Dysphasia
  • Depression
  • Developing withdrawal
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6
Q

Define Dysphasia?

Define Dysphagia?

A
  • Dysphasia
    • Deficiency in generating speech
  • Dysphagia
    • Deficiency in swallowing
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7
Q

Describe the relationship beteen Delirium and Dementia?

A
  • Delirium is a strong risk factor for the subsequent development of dementia
  • Delirum can worsen symptoms of dementia
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8
Q

Describe how Delirium can be differentiated from Dementia (Alzheimer’s)?

*** possible exam question

A
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9
Q

Describe some of the challenges when trying to differentiate between delirium and dementia?

A
  • Severe dementia can look like delirium
  • Dementia with Lewy bodies
    • Inattention, visual hallucinations, fluctuations, altered arousal
  • Mild delirium
    • May only have a cognitive deficit
  • Behavioural and psychological symptoms of dementia
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10
Q

How can uncertainties with delirium vs dementia be overcome

A
  • Informant history and observation over time
  • Involvement of MDT and specialists
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11
Q

Name 4 groups of patients where delirium often occurs?

A
  • From most common to least:
    • Intensive care
    • Post-operative
    • Hip fracture
    • Medical inpatients
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12
Q

What is used for the diagnosis of delirium?

A
  • DSM diagnostic criteria
  • 4AT screening test
  • Short screening tools
    • Short confusion assessment method
    • SQID
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13
Q

Describe ths short confusion assessment method?

A
  • Acute onset + Inattention +/- Fluctuating course
  • AND
  • Altered consciousness OR Disorganised thinking
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14
Q

Describe the 4AT screening test?

A
  • Alertness
  • AMT4
  • Attention
  • Acute change/ fluctuating course
  • Maximum 12 points
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15
Q

Describe what the scores from the 4AT screening test for delirium mean?

A
  • >=4
    • Possible delirium +/- cognitive impairment
  • 1-3
    • Possible cognitive impairment
  • 0
    • Delirium or severe cognitive impairment unlikely
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16
Q

Describe the Alertness component of the 4AT screening test?

A
  • Observe patient
  • If asleep, attempt to rouse them
  • Ask them to state their name and address
    • Normal alertness = 0
    • Mild sleepiness <10 seconds after waking = 0
    • Clearly abnormal = 4
17
Q

Describe the AMT4 component of the 4AT screening test?

A
  • Age, DOB, location, current year
    • No mistakes = 0
    • 1 mistake = 1
    • 2 or more mistakes = 2
18
Q

Describe the Attention component of the 4AT screening test?

A
  • Please tell me the months of the year in backwards order?
    • Assist with ‘What is the month before December?’ if required
  • 7+ months = 0
  • <7 months = 1
  • Untestable = 2
19
Q

Describe the Acute change or fluctuating course component of the 4AT test?

A
  • Evidence of significant fluctuation in alertness, cognition or other mental function (paranoia, hallucinations) arising over the last 2 weeks and still evident in last 24 hours
  • No = 0
  • Yes = 4
20
Q

Describe SQID?

A
  • Single question in delirium
    • Has X been more confused recently?
21
Q

Name some visual cues that can assist a doctor in diagnosing delirium?

A
  • Floccillation - plucking at the air
    • Low sensitivty, very high specificity
  • Carphology - aimlessly picking at bedclothes
22
Q

What can factors can result in a missed diagnosis of delirium?

A
  • Not looking for it
  • Older age
  • Sensory impairments (deaf)
  • Frailty
23
Q

What are the categories of predictors of delirium?

Give examples from each

A
  • Personal factors
    • Male
    • Older age
    • Dementia
    • Depression
  • Environment factors
    • Polypharmacy
    • Surgery
    • Dehydration
24
Q

What are the predisposing factors for delirium?

A
  • Personal predictors
    • Male
    • Older age
    • Dementia
    • Depression
25
Q

What are the precipitating factors for delirium?

A
  • Environmental risk factors
    • Polypharmacy
    • Surgery
    • Dehydration
26
Q

Name some medical factors which can cause delirium?

A
  • Pain
  • Hypoxia
  • Infection
  • Constipation
  • Sleep disturbance
27
Q

Name some consequences for delirium?

A
  • Increased mortality
  • Increased falls risk
  • Increased length of hospital stay
  • Increased risk of future dementia
28
Q

Describe the HELP programme for delirium in hospitals?

HELP = The hospital elder life program

A
  • Targets key delirium risk factors
    • Dehydration
    • Sensory loss
    • Immobility
    • Use of sedatives
  • Cogntivie re-orientation programme
  • Delivered by elder life specialists and trained volunteers
29
Q

Describe the TIME bundle in delirium?

A
  • Guides deliriun risk reduction
    • Triggers
    • Investigate
    • Manage
    • Engage
30
Q

Describe the management of agitation and distress within delirium?

A
  • Non-pharmacological
    • Look for acute cause (thirst, pain, hunger, constipation)
    • Repeated re-orientation
    • Reassurance
  • Pharmacological (only if required)
    • Antipsychotics
      • Haloperidol, risperidone
    • Lorazepam
31
Q
A

Y4: Geriatric Medicine (9 decks)

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