delirium and dementia Flashcards
8 aspects of cognition
-Attention
-Orientation
-Memory (short & long-term)
-Language
-Judgment
-Interpersonal relationships (social cognition, reading situation))
-Performing actions
-Problem solving
An acute (sudden onset) disturbance of cognition, manifested by short-term confusion, excitement, disorientation, and clouded consciousness. Reversible
delirium
what is hallucinations and delusions common in? Delirium or Dementia?
delirium
Progressive, irreversible decline in cognitive ability in the presence of clear consciousness
dementia
delirium diagnostic criteria
-a disturbance in attention or awareness
-Develops over a short period of time (hours to days) and fluctuates in severity over the course of the day
-An additional disturbance in cognition (memory deficit, disorientation, language, visuospatial ability or perception
direct consequence of anther medical condition (withdrawal, exposure to toxin)
delirium
delirium onset- head injury, seizure
rapid- hours
delirium onset- metabolic, systemic illness
slow- hours to days
Delirium assessment mnemonic: delirium
-Drugs
-Electrolyte imbalance
-Low O2 sats
-Infection
-Reduced sensory input
-Intracranial
-Urinary or renal retention
-Myocardial
delirium clinical findings
-Distractible, needing continual re-focusing
-Disorganized in thinking, reflected by alterations in speech
-Impaired reasoning and goal-directed behavior
-Disorientation to time and place
-Impairment of recent memory
delirium predisposing factors
-Low activity level
-Hx of falls
-visual/hearing impairment
-Dehydration
-Polypharmacy
-ETOH/drug abuse
-Hx of delirium
-Co-existing dementia/cognitive impairment
delirium precipitating factors
-Infections
-Hypoxia
-Fever or hypothermia
-Anemia
-Malnutrition
-Head trauma
delirium medical treatment
-Identify and treat underlying cause(s)
-Remain with pt for monitoring
-Treat psychosis with agitation and aggression with low dose antipsychotic (SGA). FGA associated with prolonged QT interval
-Treat substance induced delirium with benzodiazepine
-Treat sleep disturbances with melatonin or Rozerem (ramelteon)
delirium treatment goals
-Prevention (most common complication of all hospitalized patients!)
Monitoring
-Rapid assessment and identification
-Early intervention
-Injury prevention
diagnostic criteria: -Evidence of significant cognitive decline from a previous level performance in one or more cognitive domains: complex attention, executive function, learning, memory, language, perceptual-motor, or social cognition, based on:
-Concern that there has been significant decline in cognitive functions
-Substantial impairment in cognitive performance
neurocognitive disorder
neurocognitive disorder: mild or major?
-Modest cognitive decline
-Concern about the decline
-Impairment does not interfere with independence
-Do not occur in the context of a delirium
-Not better explained by MDD or schizophrenia
mild
neurocognitive disorder: mild or major?
-Significant cognitive decline
-Concern about the decline
-Deficits interfere with independence with daily activities
-Do not occur in the context of a delirium
-Not better explained by -MDD or schizophrenia
major
primary neurocognitive disorder
-alzheimers diseae
-Major sign of an organic brain disease, not directly related to any other organic illness
secondary neurocognitive disorder
Created by or related to another disease or condition such as HIV or a brain tumor
neurocognitive disorder clinical findings
-Impairment in abstract thinking, judgment, impulse control
-Behavior may be uninhibited and inappropriate
-Very rarely reversible
-Irritable, moody, outbursts
-Apraxia (inability to carry out motor functions)
late signs of neurocognitive disorder
Chair or bed-bound
Very active hands, repetitive movements
Grunting
Depressed immune system functioning
Death caused by infection, sepsis, or aspiration
most common neurocognitive disorder
alzheimers disease
Alzheimers disease onset speed
slow, insidious
alzheimers disease course
progressive and deteriorating
