Delirium and dementia

Question 1

Causes of delirium

Answer 1

P: Pain

I: Infection

N: Nutrition

C: Constipation

H: Hydration

M: Medication - opiates/ steroids

E: Electrolytes

Question 2

Differentials for delirium

Answer 2

Ageing

Mild cognitive impairment

Delirium

Depression

Amnesic syndrome

Reversible causes: space occupying lesions, alcohol abuse, medication effects, thyroid problems, vitamin deficiencies

Question 3

What is mild cognitive impairment?

Answer 3

• Intermediate stage bwteen normal age-related change and dementia
• Subtle impairments in =>1 of: memory, language, visuospatial skills, planning, judgement
• Objective evidence of cognitive impairment
• No impact on ADLs

Causes: early dementia, physical health problems, medication, mental health e.g. depression

50% never progress to dementia

10-20% improve

Question 4

Risk factors for delirium

Answer 4

Older

Cerebral compromise

Chronic medical problems

Renal impairment

Functional disability

Previous delirium

Psychiatric hx

Sensory impairment e.g. deafness

Polypharmacy

Question 5

Delirium vs dementia

Answer 5

Question 6

What is amnesic syndrome?

Answer 6

• Impairment of recent memory: difficulty learning new material
• Preservation of immediate recall e.g. 10-20 seconds
• Confabulation: false memories
• Other cognitive functions normally well preserved
• Alcohol is the most common cause - Korsakoff’s B1 deficiency
• Toxins
• Head trauma
• Tumours, stroke, infection