Dementia and Delirium (things not covered in other blocks) Flashcards
What are the benefits of early screening for cognitive impairment?
- 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
What are the points of AMT
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
What score in AMT10 indicates cognitive impairment?
< or equal to 7
What is the MMSE
30 point test
Sections include: Orientation, Registration, Attention and Calculation, Recall, Language, Copying intersecting pentagons
What is the difference between Mild Cognitive Impairment and Dementia?
Mild cognitive impairment doesn’t affect ADLs
Describe the presenting features of Delirium using the mnemonic ‘DELIRIUM’
Disordered Thinking Euphoric Language Impaired Illusions Reversal of Sleep Cycle Inattention Unaware Memory Deficits
Describe the ICD10 features of Delirium
Impairment of consciousness and cognition Global Disturbance in Cognition Psychomotor disturbance Disturbance of sleep wake cycle Emotional Disturbance
Describe the CAM assessment method
1) Acute Onset and Fluctuating
2) Inattention (serial 7s)
3) Disorganised thinking
4) Altered Conscious
Requires 1 and 2 and 3/4
What might you need to consider applying for with Delirious Patients?
Temporary Mental Capacity Act or DOLS
Who might you refer Delirious patients to?
FOPAL
Define Dementia
Acquired decline in memory and cognitive function to sufficiently impair ADLs, present for at least 6 months
Name four reversible causes of Dementia
Visual/Hearing impairment
Nutritional Deficiencies
Normal Pressure Hydrocephalus
Hypothyroid
Name a contraindication for Donepazil
Bradycardia
Name a contraindication for Memantine
Renal Failure
What is the Ninds Airen Criteria for Vascular Dementia?
- Cognitive decline impairing ADLs
- Cerebrovascular disease on imaging
How is Vascular Dementia managed?
Stroke Prevention
If mixed (with Alzheimers) can use Alzheimers medication
How can DLB be managed?
Memantine and Donepazil
Name four things that would make you consider delirium in a patient
- Patient is over 65
- Abbreviated AMT < 4 (Age, DOB, Place, Year)
- Patient more confused/withdrawn than normal
- 4AT>4
What is the 4AT?
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)
Name five immediate actions for the delirious patient
- 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
How would you manage a wandering delirious patient?
- Close observation within a safe and reasonably closed environment (refer to DOLS)
- Allow wandering in safe environment
- Ask relatives to offer meaningful distractions
How would you manage Delirious Patients false ideas?
- Avoid contraindicating and challenging patients
- Change the subject or use distraction techniques
- Concentrate on their feeling behind what they’re saying
Who is part of the FOPAL team?
Consultant Geriatrician Physicians Assistant Specialist Nurses Physiotherapists Occupational Therapists
What is the aim of FOPAL
Comprehensive review of the patient, including sourcing collateral information, to ensure timely and appropriate discharge for patients with complex needs
