Dementia and Delirium (things not covered in other blocks)

Question 1

What are the benefits of early screening for cognitive impairment?

Answer 1

• If negative, concerns are alleviated
• Can manage comorbidities more effectively
• Avert or address any safety issues
• Allows person to finalise an advanced directive
• Encourages participation in clinical research

Question 2

What are the points of AMT

Answer 2

Age in Years
Time of Day
Name of Hospital
Remember Address
Recognise Person 
Current Year 
Current Monarch 
DOB
Date of WW2
Count backwards 20-1
Recall address

Question 3

What score in AMT10 indicates cognitive impairment?

Answer 3

< or equal to 7

Question 4

What is the MMSE

Answer 4

30 point test

Sections include: Orientation, Registration, Attention and Calculation, Recall, Language, Copying intersecting pentagons

Question 5

What is the difference between Mild Cognitive Impairment and Dementia?

Answer 5

Mild cognitive impairment doesn’t affect ADLs

Question 6

Describe the presenting features of Delirium using the mnemonic ‘DELIRIUM’

Answer 6

Disordered Thinking
Euphoric
Language Impaired
Illusions
Reversal of Sleep Cycle
Inattention
Unaware
Memory Deficits

Question 7

Describe the ICD10 features of Delirium

Answer 7

Impairment of consciousness and cognition
Global Disturbance in Cognition 
Psychomotor disturbance
Disturbance of sleep wake cycle
Emotional Disturbance

Question 8

Describe the CAM assessment method

Answer 8

1) Acute Onset and Fluctuating
2) Inattention (serial 7s)
3) Disorganised thinking
4) Altered Conscious

Requires 1 and 2 and 3/4

Question 9

What might you need to consider applying for with Delirious Patients?

Answer 9

Temporary Mental Capacity Act or DOLS

Question 10

Who might you refer Delirious patients to?

Answer 10

FOPAL

Question 11

Define Dementia

Answer 11

Acquired decline in memory and cognitive function to sufficiently impair ADLs, present for at least 6 months

Question 12

Name four reversible causes of Dementia

Answer 12

Visual/Hearing impairment
Nutritional Deficiencies
Normal Pressure Hydrocephalus
Hypothyroid

Question 13

Name a contraindication for Donepazil

Answer 13

Bradycardia

Question 14

Name a contraindication for Memantine

Answer 14

Renal Failure

Question 15

What is the Ninds Airen Criteria for Vascular Dementia?

Answer 15

• Cognitive decline impairing ADLs

- Cerebrovascular disease on imaging

Question 16

How is Vascular Dementia managed?

Answer 16

Stroke Prevention

If mixed (with Alzheimers) can use Alzheimers medication

Question 17

How can DLB be managed?

Answer 17

Memantine and Donepazil

Question 18

Name four things that would make you consider delirium in a patient

Answer 18

• Patient is over 65
• Abbreviated AMT < 4 (Age, DOB, Place, Year)
• Patient more confused/withdrawn than normal
• 4AT>4

Question 19

What is the 4AT?

Answer 19

1) Alertness (0 is normal, 4 is not)
2) AMT4 (0 no mistakes, 2 is one mistake, 4 is more than one mistake)
3) Attention (serial sevens backwards, 0,1 or 2)
4) Acute and Fluctuant from History (Yes =4, No = 0)

Question 20

Name five immediate actions for the delirious patient

Answer 20

• Focussed history/examination and collateral
• Identify and treat underlying cause (go down SIRS pathway if fitting criteria)
• Complete a ‘Know Me a Better’ Profile
• More in depth cognitive assessment (MMSE, AMT10)
• Update and involve relatives

Question 21

How would you manage a wandering delirious patient?

Answer 21

• Close observation within a safe and reasonably closed environment (refer to DOLS)
• Allow wandering in safe environment
• Ask relatives to offer meaningful distractions

Question 22

How would you manage Delirious Patients false ideas?

Answer 22

• Avoid contraindicating and challenging patients
• Change the subject or use distraction techniques
• Concentrate on their feeling behind what they’re saying

Question 23

Who is part of the FOPAL team?

Answer 23

Consultant Geriatrician
Physicians Assistant
Specialist Nurses
Physiotherapists
Occupational Therapists

Question 24

What is the aim of FOPAL

Answer 24

Comprehensive review of the patient, including sourcing collateral information, to ensure timely and appropriate discharge for patients with complex needs