Elderly Confusion Flashcards
What are the types of delirium?
Hypoactive - Lethargic, stupor
Hyperactive - Combative, agitated & restless
Mixed
How does delirium typically present?
with changes in cognition e.g. memory. perception, language & hallucinations
It has an acute onset and fluctuates, typically being worse at night
Can also affect sleep cycle & emotions
What causes delirium?
It’s generally triggered by multiple factors such as:
- Infection
- Dehydration or biochemical imbalance
- Pain
- Sleep disturbance
- Drugs (or drug withdrawel)
- Hypoxia
- Brain injury
- Environment or social changes
How do we diagnose Delirium?
It’s a clinical diagnosis and we can use the 4AT score to help us. 4 or more points = possible delirium +/- cognitive impairment
What’s included in a 4AT score?
Alertness
AMT4 (Age, DOB, location & yr)
Attention (tell me months of year backwards starting at december)
Acute change or fluctuation
How do we assess a patient with delirium?
Full H & E including neuro
Time bundle - A systematic way of identifying triggers and initiating treatment
What non-pharmacological ways can we treat delirium?
First make sure you explain delirium to the patient and carer.
- Reassurance
- Encourage early mobility
- Correct any sensory impairment
- Normalise sleep-wake cycle
- Ensure continuity of environment & carers
- Avoid catheters and venflons
When would you use drugs in delirium?
Only if distress can’t be resolved otherwise.
Or if a danger to themselves or others
DONT JUST SEDATE THE POOR FUCKERS
What drugs can you use for delirium?
Firstly stop potentially precipitating drugs, mostly anti-cholinergics and sedatives
Start with low dose of 12.5mg quetiapine orally
Define dementia?
Acquired decline in cognitive functions in an alert person severe enough to cause functional impairment and present >6months
Functional impairment means forgetting tablets, can’t work phone or difficulty washing/dressing etc (as long as it’s a cognitive cause)
What are the big types of dementia?
Alzheimers
Vascular dementia
Lewy body dementia
Frontotemporal dementia
How does alzheimers present?
Slow insidious onset with memory going first
Think age, vascular and genetic risk factors
How would vascular dementia present?
Step-like deterioration
Starts with executive function and associated with gait problems
Look for vascular risk factors e.g. IHD, DM, AD or PVD
How does lewy body dementia present?
Very fluctuant
Often comes with hallucinations and falls
Possible parkinsonism
How does frontotemporal dementia present?
Earlier
Behavioral changes
Language problems
Memory (though often unaffected)
