Delirium Flashcards
what is criterion A for delirium
a disturbance in ATTENTION (i.e reduced ability to direct, focus, sustain and shift attention) and AWARENESS (reduced orientation to environment)
what is criterion B for delirium
the disturbance develops over a SHORT period of time (usually hours to days), represents a CHANGE from baseline attention and awareness and tends to FLUCTUATE in severity DURING THE COURSE OF A DAY
what is criterion C for delirium
an additional disturbance in COGNITION (i.e memory deficit, disorientation, language, visuospatial ability or perception)
what is criterion D for delirium
the disturbances in criteria A and C are not better explained by another preexisting, established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma
what is criterion E for delirium
there IS evidence from the history, physical exam or lab findings that the disturbance is a DIRECT, PHYSIOLOGICAL CONSEQUENCE of another medical condition, substance intoxication or withdrawal, or exposure to a toxin or is due to multiple etiologies
list etiology specifiers for delirium
substance intoxication delirium substance withdrawal delirium medication induced delirium delirium due to another medical condition delirium due to multiple etiologies
list timeline specifiers for delirium
acute–> lasting a few hours or days persistent–> lasting weeks or months
list level of activity specifiers for delirium
hyperactive hypoactive mixed level of activity
define hyperactive delirium
individual has hyperactive level of psychomotor activity that may be accompanied by mood lability, agitation, and/or refusal to cooperate with medical care
define hypoactive delirium
individual has a hypoactive level of psychomotor activity that may be accompanied by sluggishness and lethargy that approaches stupor
define mixed level of activity delirium
normal level of psychomotor activity even though attention and awareness are disturbed also includes those whose activity level rapidly fluctuates
when should you diagnose substance intoxication delirium instead of just substance intoxication
when symptoms in criteria A and C predominate in the clinical picture and when they are sufficiently severe to warrant medical attention *the same applies to substance withdrawal delirium
how long does delirium usually last in hospital settings
about 1 week some symptoms often persist even after individuals are discharged from the hospital
what is the essential feature of delirium
a disturbance of attention or awareness that is accompanied by a change in baseline cognition that cannot be better explained by a preexisting or evolving NCD
how might a patients disturbance in attention present
reduced ability to direct, focus, sustain and shift attention i.e questions must be repeated because individuals attention wanders, or individual may perseverate with an answer to a previous question rather than appropriately shifting attention easily distracted by irrelevant stimuli
how might disturbance in awareness present
reduced orientation to the environment or at times even to oneself
what time of day does delirium often worsen and why
worsens in evening and nighttime when there is less external orienting stimuli
which patients are more vulnerable to delirium
those with underlying NCD as the impaired brain function of those with major or mild MCD renders them more vulnerable to delirium
which elements of cognition may be impaired in delirium (criterion C)
memory and learning (particularly RECENT MEMORY) disorientation (particularly to TIME and PLACE) alteration in language perceptual distortion or a perceptual-motor disturbance
which perceptual disturbances can accompany delirium
misinterpretations illusions hallucinations *these disturbances are typically VISUAL but may occur in other modalities as well and range from simple and uniform to highly complex
what is the continuum on which delirium finds itself
normal attention arousal–> delirium –> coma (coma is lack of any response to verbal stimuli–delirium cannot be diagnosed in the context of coma)
how do you diagnose those patients who show only minimal responses to verbal stimuli
these patients are incapable of engaging with attempts at standardized testing or even interview this inability to engage should be classified as SEVERE INATTENTION low arousal states of acute onset should be recognized as indicating severe inattention and cognitive change and hence delirium
how does delirium affect sleep
often associated with disturbance in the sleep-wake cycle can include: daytime sleepiness nighttime agitation difficulty falling asleep excessive sleepiness throughout the day wakefulness throughout the night can sometimes have COMPLETE REVERSAL of night-day sleep-wake cycle
how important are sleep wake disturbances in delirium
very common have been proposed as a core criterion for the diagnosis
how does delirium affect the patients emotional state
may exhibit emotional disturbances such as anxiety, fear, depression, irritability, anger, euphoria, apathy may be rapid and unpredictable shifts between emotional states may also be evident in calling out, screaming, cursing, muttering, moaning or making other sounds behaviours especially prevalent at night
in which populations is the prevalence of delirium the highest
hospitalized older adults varies depending on individual characteristics, setting of care, sensitivity of detection method
what is the prevalence of delirium in the community
1-2% (DSM 5) –> increases with age
what is the prevalence of delirium in the community in those above 85 years old
14% (DSM 5)
what is the prevalence of delirium in older adults presenting to ERs
10-30% (DSM 5) in these cases, the delirium often represents a medical illness
