Dementia / delirium / confusion / capacity Flashcards
List some consequences of delirium if left un-recognised and un-treated
- Increased hospital stay / nursing care
- Risk of cognitive / functional decline
- Delayed rehabilitation / post-op recovery
- Distress to caregivers
- Distressing in terminally ill patients (psychosocial closure)
- Risk of mortality for up to 2 years after
- Risk of readmission or institutionalisation
State the 4 topics to cover in the AMT-4 assessment for confusion
DOB
Age
Place
Year
List key modifiable risk factors for the development of Alzheimer’s / dementia
Medical:
- HTN
- Diabetes
- Hearing impairment
Lifestyle:
- Smoking
- Obesity
- Physical inactivity
- Excessive alcohol consumption
Social:
- Poor education
- Poor social contact
Other:
- Depression
- Traumatic brain injury (TBI)
- Air pollution
List some predisposing factors that make a patient more at risk of developing delirium
- Previous delirium
Non-modifiable:
- Increased age (>65)
- Male
Modifiable:
- Alcohol abuse
- Dehydration
- Malnutrition
Medical:
- Preexisting cognitive impairment
- Poor vision / hearing
- Immobility
- Medical conditions e.g. stroke, renal or hepatic impairment, HIV, fractures or trauma, neurological disease
List some risk factors for someone developing delirium (THINK DELIRIUM)
THINK DELIRIUM
Trauma
Hypoxia
Increasing age/frailty
Neck of femur fracture
smoKing or alcohol
Drugs e.g. new/stopped
Environment
Lack of sleep
Imbalanced electrolytes (renal failure, Na, Ca, glucose, LFTs)
Retention (urinary or consitpation_
Infection / sepsis
Uncontrolled pain
Medical conditions e.g. dementia, Parkinson’s disease
List 4 parameters assessed in the confusion assessment method (CAM)
Acute onset with fluctuations
Inattention
Disorganised thinking
Altered level of consciousness
List some presenting features for delirium
Hyperative:
- High energy
- Agitation
- Pressured speech
- Restlessness
Hypoactive:
- Lack of energy
- Withdrawn
- Poor motivation
Both:
- Difficulty maintaining attention / concentration (worse in evening = sundowning)
- Reduced ability to solve problems
- Poor sleep
- Reversed sleep-wake cycle
- Hallucinations / delusions / paranoia / thought disorganisation
Outline how to manage a patient with delirium
1st line = non-pharmacological
- Modify surroundings
- Ensure visual and auditory aids used
- Involvement of family / friends + familiar items
- Close nursing
- Swap for a room with a window view
- Adequate control of pain
- Physical activity
Pharmacological:
- Antipsychotics (generally 2nd generation e.g. Aripiprazole)
- Benzodiazepines e.g. Haloperidol (unless Parkinson’s, then Lorazepam)
State the first line antipsychotic to use in delirium (if absoloutely needed after de-escalation techniques etc.)
Haloperidol (unless if Parkinson’s disease, then Lorazepam)
List some domains which dementia affects e.g. memory
- Learning and memory
- Executive function
- Motor ability
- Language
- Social cognition
- Complex attention
= affects independent function of activities of daily living
State the leading risk factor for dementia
Increasing age
List some risk factors for dementia
Non-modifiable:
- Increasing age
- Early life depression
Modifiable:
- Smoking
- Excessive alcohol
- CVS risk factors e.g. HTN, hypercholesterolaemia
- Diabetes
- Obesity
- CHF
- Atrial fibrillation
- OSA
List 2 protective factors against the development of dementia
- More years of formal education
- Social engagement and cognitive stimulation activities e.g. puzzles
List some presenting symptoms of dementia
Early stage:
- Memory loss (recent)
- Inability to learn new information
- Repetitive questions, telling of stories
- Forgetting appointments / cooking
- Losing possessions
= limited impact on ADLs
Later stages:
- Agnosia
- Apraxia (unable to perform tasks or movements when asked)
- Worsening executive functioning e.g. managing medication, finances, preparing meals
- Worsening social cognition e.g. difficulty recognising social cues, disinhibition, change in personality
Outline some features of middle and later stages of dementia
Middle:
- More prominent memory issues
- Issues with executive function & language
- Changes in behaviour
- Awareness of disease reduces
= Difficulties with complex ADLs (easy motor ADLs generally okay
= requires supervision, but not constantly
Later:
- Severe and pervasive memory problems
- Severe disorientation
- Failure to recognise familiar people
- Speech difficulties
- Marked behaviour change e.g. disinhibition, agitation, irritability
- Disability is severe
= unable to do almost all ADLs
= requires almost constant supervision