Delirium/Dementia

Question 1

What is considered an “Abnormal” score on a Mini Mental Status Exam (MMSE)

Answer 1

<24

Question 2

What MMSE indicates increased odds of dementia? What level of education is this?

Answer 2

<21

Abnormal for 8th grade education

Question 3

What MMSE range is considered NO cognitive impairment?

Answer 3

24-30

Question 4

What is the risk of death in hospitals associated with delirium?

Answer 4

10 fold risk

Question 5

List the 3-5 fold increased risks associated with delirium (other than death)

Answer 5

1. Nosocomial complications
2. Prolonged stay
3. Post-acute NH placement

Question 6

How long following discharge are patients at an increased risk for poor functional recovery and increased risk of death following their delirium?

Answer 6

2 years

Question 7

What % of delirium is recognized by nurses? by physicians?

Answer 7

Nurses=50%

MD’s=20%

Question 8

Clinically, what do we use to diagnose delirium?

Answer 8

Confusion Assessment Method (CAM)= 95% sensitivity and specificity

Question 9

What is the MC type of delirium

Answer 9

HYPOactive delirium=50%

Question 10

What is the other type of delirium? %?

Answer 10

HYPERactive delirium=25%

Question 11

What type of delirium has a poorer prognosis ? Why?

Answer 11

HYPOactive delirium:

1. Less recognized
2. Not appropriate tx

Question 12

List the two Neuropathophysiology causes for delirium

Answer 12

1. Cholinergic deficiency

2. Inflammation

Question 13

Delirium Etiology in cholinergic deficiency? Treatment?

Answer 13

Anticholinergic Drug OD

Tx: Physostigmine

Question 14

What increases with inflammation associated delirium?

Answer 14

1. C-Reactie Protein
2. IL-1B
3. TNF

Question 15

What patients does inflammation delirium especially affect?

Answer 15

1. Postop pt’s
2. CA pt’s
3. Sepsis pt’s

Question 16

List some predisposing factors to delirium

Answer 16

1. Male
2. Hx of Etoh abuse
3. Sensory impairment: decreased vision/hearing
4. Advanced age
5. Functional impairment in ADL’s
6. Dementia
7. Medical Comorbidity

Question 17

List some precipitating factors

Answer 17

1. Acute cardiac/pulmonary event
2. Fecal impaction
3. Urinary retention
4. Infections: Urinary and Respiratory
5. Drug Withdrawal

Question 18

List the top 3 surgeries that increase the incidence of post delirium. By how much?

Answer 18

1. Cardiac surgery
2. AAA repair
3. Hip repair

Increased by 50%

Question 19

How many pre-op risk factors significantly increase incidence of dementia? by how much?

Answer 19

3+ RF’s

50%

Question 20

What postop day is peak onset for delirium?

Answer 20

2nd

Question 21

What opiod is especially associated with post-op delirium?

Answer 21

Meperidine

Question 22

What is the BEST treatment in delirium?

Answer 22

Prevention

Question 23

What diagnostic studies are RARELY helpful in the assessment of delirium?

Answer 23

1. Cerebral imaging: Except in head trauma or new focal neuro findings
2. EEG and CSF: Except in seizure activity and meningeal signs

Question 24

What is the most successful management of delirium?

Answer 24

Multifactorial approach

Question 25

What is the appropriate behavioral management of delirium?

Answer 25

“Social Restraint”= Sitter

Question 26

Who should receive Lorazepam?

Answer 26

1. Sedative and Alcohol withdrawal

2. Hx of Neurleptic malignant signdrome

Question 27

What do you need to assess/monitor for IF you give a patient Haloperidol?

Answer 27

1. Akathesia
2. Extrapyramdial effects
3. QT prolongation
4. Torsades
5. Withdrawal dyskinesias

Question 28

List some rehab management in delirium

Answer 28

1. Orienting stimuli: clock
2. Socialization
3. Appropriate use of eyeglasses and hearing aids
4. Mobilize ASAP
5. Adequate fluids and nutrition
6. PT/Family education