Dementia and Delirium Flashcards
What are the risk factors for delirium?
- Dementia
- Multiple co-morbidities
- Physical frailty
- Older age
- Sensory impairments
What are the potential precipitating factors for a delirium?
- drug initiation
- medical illness
- systemic infection
- metabolic derangement
- surgery
- pain
- brain disorders e.g. stroke, seizures
- systemic organ failure
What are the first line investigations for a suspected delirium?
- FBC for WCC
- CRP
- U&Es
- LFTs
- TFTs
- blood glucose
- urinalysis
- ECG
- CXR
What are the second line investigations for a suspected delirium?
- haematinics
- serum calcium
- ABG
- cultures e.g. blood, urine, sputum etc
- CT/MRI head
- EEG
- toxicology screen
- bladder scan to r/o urinary retention
- LP
What are the four key features of delirium?
- disturbance of consciousness with reduced ability to focus or shift attention
- changes to cognition or new perceptual disturbances that are not already accounted for by existing diagnoses
- develops over a short period of time and fluctuates throughout the day
- history supports an underlying precipitating factor
What is the prevalence of delirium among hospitalised adults?
- up to 30% of medical patients
- up to 50% of surgical patients
Does having dementia increase your chance of getting delirium?
patients with dementia have a 5-10 fold increased risk of delirium
What are the differential diagnosis for suspected delirium?
- dementia
- focal neurological syndromes e.g. wernicke’s encephalopathy, frontal lobe lesions
- global cerebral pathologies e.g. ischaemic stroke
- non-convulsive status epilepticus
- primary psychiatric illness e.g. depression, mania, schizophrenia
What is the prognosis for delirium?
- 40% persist at 2 weeks, 33% persist at 1 month, up to 20% of patients never recover
- associated with increased mortality (60% more likely at 1 year)
- more likely to have a longer hospital stay
- eightfold increased risk of developing dementia in next three years
How do you manage delirium?
- treat the underlying cause e.g. abx, laxatives, analgesia, drug review
- manage the environment e.g. involve family, clocks and calendars, correct sensory impairments, avoid multiple bed moves, minimise provocation
- ABC observation to manage difficult behaviours non-pharmacologically e.g. identify and remove ANTECEDENTS, identify what the patients BEHAVIOUR is trying to achieve and help them achieve it safely, consider the CONSEQUENCES of the behaviour e.g. is is harmful, what is the harm, does the risk of harm outweigh the risk of restraint or sedation?
- drug management of difficult behaviours as a last resort e.g. if patient otherwise poses a greater risk of immediate harm to themselves or others - lorazepam and/or haloperidol
What are the diagnostic criteria for dementia?
- impairment of memory and [language impairment or executive function impairment or agnosia or apraxia]
- which impairs functioning
- for at least 6 months
- and isn’t explained by other medical or psychiatric conditions
What are the risk factors for developing dementia?
Modifiable: - smoking - atherosclerosis - alcohol - high cholesterol - obesity - low standard of education Non-modifiable: - genetics - age - MCI
What is the prevalence of each subtype of dementia?
- AD 62%
- VaD 17%
- Mixed 10%
- Lewy-body 4%
- Frontotemporal 2%
- Parkinson’s 2%
What is the prevalence of dementia in the UK?
- 5% of over 65s
- 20% of over 80s
What cerebral changes are associated with AD?
- atrophy of the cerebrum, particularly hippocampus
- enlargement of ventricles
- beta amyloid plaques
- neurofibrillary tangles (tau protein)
- reduced neurotransmitter function
