Delirium (lecture) Flashcards
What is delirium?
A state of mental confusion that develops quickly and often fluctuates in intensity. It involves reduced ability to focus, sustain, or shift attention.
How is delirium different from dementia?
Delirium develops over a short period (hours to days) and fluctuates throughout the day. Dementia is a chronic, gradual decline.
What are the key characteristics of delirium?
Disturbance of consciousness, reduced attention, cognitive change, perceptual disturbance, and fluctuating symptoms.
What neurotransmitter imbalance is commonly associated with delirium?
Acetylcholine deficiency and dopamine excess.
What is the acetylcholine reduction hypothesis related to delirium?
Anticholinergic drugs blocking acetylcholine can cause delirium. Drugs increasing acetylcholine are sometimes used as treatment.
What metabolic disturbances are commonly linked to delirium?
Electrolyte imbalances, dehydration, glucose abnormalities.
What is the dopamine excess hypothesis related to delirium?
Elevated dopamine levels may contribute to symptoms of delirium.
How does inflammation contribute to delirium?
Inflammatory cytokines and microglial overactivation can disrupt brain function, especially in older adults.
Why does blood-brain barrier (BBB) permeability increase the risk of delirium?
Increased BBB permeability with age allows inflammation-related damage to affect the brain more easily.
What is the neuroinflammatory hypothesis related to delirium?
Proposes that elevated inflammatory markers during episodes contribute to cognitive impairment and delirium.
Which areas of the brain are primarily affected by metabolic disturbances in delirium?
The frontal cortex and hippocampus, leading to changes in attention, memory, and cognition.
What are the main neurotransmitters involved in delirium pathogenesis?
Acetylcholine (deficiency) and Dopamine (excess)
What role does age play in the development of delirium?
Age increases the risk due to higher BBB permeability, microglial overactivation, and vulnerability to inflammatory processes.
What are the common risk factors for developing delirium?
Dementia, multiple comorbidities, physical frailty, older age, sensory impairment, sleep deprivation.
List precipitating factors for delirium.
Drug initiation/withdrawal, medical illness, surgery, pain, brain disorders (e.g., stroke, seizure).
What are the first line investigations for delirium?
Blood tests (WCC, CRP, U&Es, LFTs, glucose, TFT, B12, Folate), ECG, Pulse oximetry, Urine analysis.
What are the second line investigations for delirium?
CT/MRI head scan, Lumbar puncture, Bladder scan, EEG (if status epilepticus suspected).
What mnemonic can be used to recall causes of delirium?
PINCHME: Pain, Infection, Nutrition, Constipation, Hydration, Medication, Environment.
What does the mnemonic DELIRIUM stand for?
Drugs, Epilepsy/Electrolyte imbalance, Liver failure/Low oxygen, Infection, Retention, Intracranial, Uremia, Metabolism.
How does pain contribute to delirium?
Pain can cause agitation, distress, and alter cognitive function, especially in older adults.
Why are anticholinergic medications particularly problematic in delirium?
They block acetylcholine, which is crucial for cognitive function. Reduced acetylcholine is linked to delirium.
What role does dehydration play in delirium?
Dehydration causes electrolyte imbalance and reduced blood flow to the brain, impairing cognition.
What infections are commonly associated with delirium?
UTIs, pneumonia, sepsis, meningitis, encephalitis.
How can surgery precipitate delirium?
Anaesthesia, pain, metabolic derangements, and post-operative complications can all contribute.
What brain disorders are linked to delirium?
Stroke, seizure, intracranial haemorrhage, and brain tumours.
What is the preferred imaging method for investigating delirium?
Contrast MRI to rule out structural causes such as stroke or tumour.
What electrolyte imbalances are commonly linked to delirium?
Hyponatremia, hypercalcemia, hypoglycaemia.
Why is a lumbar puncture used in investigating delirium?
To check for infection (e.g., meningitis) or elevated intracranial pressure.
How does age increase the risk of delirium?
Increased blood-brain barrier permeability, reduced neurotransmitter levels, and greater susceptibility to inflammation.
What clinical signs may indicate that a patient is experiencing delirium?
Fluctuating alertness, confusion, hallucinations, agitation, or sudden changes in cognition.
How can unfamiliar environments contribute to delirium?
Sensory overload or deprivation, disruption of routine, and unfamiliarity can trigger or worsen delirium.
What is the significance of retention (urinary or fecal) in delirium?
Retention causes discomfort, pain, and electrolyte disturbances, which can precipitate delirium.
How is low oxygen (e.g., MI, PE) related to delirium?
Reduced oxygen supply to the brain impairs cognitive function and can cause confusion or delirium.
What are the key components of a risk assessment for delirium?
Screening patients for delirium risk, minimizing polypharmacy, optimizing pain management, early mobilization, environmental modification, hydration, nutrition, and cognitive stimulation.
How can environmental modification help prevent delirium?
Adjusting lighting, reducing noise, providing familiar objects, using clocks and calendars to aid orientation.
What role does cognitive stimulation play in delirium prevention?
Providing meaningful activities to engage patients and support orientation.
What is the purpose of the Mental Capacity Act (2005)?
To protect and empower individuals who may lack the capacity to make their own decisions, ensuring decisions are made in their best interest.
According to the Mental Capacity Act, when does a person lack capacity?
When they cannot understand, retain, weigh up, or communicate a decision.
What is the principle of ‘least restrictive option’ in the Mental Capacity Act?
Ensuring that care or treatment is provided in the least restrictive manner possible.
What are Deprivation of Liberties Safeguards (DOLS)?
Legal measures used when a patient cannot consent to treatment and requires continuous supervision, with restricted freedom to leave.
When are DOLS most commonly applied?
In hospital and care home settings where patients lack capacity to consent and require continuous supervision.
What is the key difference between delirium and dementia in terms of onset?
Delirium has an acute onset (hours to days) while dementia develops gradually (months to years).
What is the purpose of minimizing polypharmacy in delirium prevention?
To reduce the risk of medication-induced delirium, especially from anticholinergics and sedatives.
What environmental modifications are recommended for patients with delirium?
Soft lighting, single rooms, reducing noise, providing orientation cues like clocks and calendars.
How does early mobilization help in delirium prevention?
It prevents deconditioning, maintains physical function, and reduces risk of delirium.
How should pain be managed to prevent delirium?
Adequate pain relief using simple analgesics and avoiding sedative medications where possible.
What is the importance of hydration and nutrition in preventing delirium?
Dehydration and malnutrition are risk factors for delirium, so maintaining adequate hydration and nutrition is essential.
