Elderly confusion Flashcards
Confusion and potential reasons
vague, non-medical term
deafness, complex task, cultural differences, brain problem
Confusion or cognition?
cognition
List some components of cognition
memory
language
executive function
perceptual-motor function
Why is assessing cognition important?
relevant to current medical problem
capacity?
increase risk of death, LOS, discharge to care
improve it
alter communication/information/involve family
appropriateness of investigations, tests, treatments
History
onset - rapid? when it started
course - fluctuating, progressive decline
associated features - illness, functional loss
remember collateral history!
2 common causes of cognitive impairment
delirium and dementia
Key features of delirium (3)
disturbed consciousness - hypoactive/hyperactive/mixed
Change in cognition - memory/perceptual/illusions
acute onset and fluctuant
Other features of delirium
disturbed sleep-wake cycle, psychomotor (falls) and emotional
Who gets delirium?
extremes of age
“frail” brain
cognitive frailty eg MND, MS etc
What causes delirium?
no one really knows
maladaptive pro-inflammatory response
What precipitates delirium - loads of examples
infection - UTI drugs - ACEI,NSAIDS brain injury eg stroke environmental changes urinary retention and constipation biochemical disturbance dehydration hypoxia pain sleep disturbance alcohol or drug withdrawl
Why is delirium important?
20-30% of all inpatients
up to 50% post op
up to 85% in last few weeks of life
massive morbidity and mortality
Morbidity and mortality associated with delirium
risk of death, LOS, institutionalisation and persistent functional decline
How to diagnose delirium?
4AT
What to do when we find delirium?
TIME bundle full history and exam explain diagnosis pharmacological measures non-pharm methods
Non-pharmacological treatment of delirium
re-orientate and reassure agitated patients
encourage early mobility an self-care
correction of sensory impairment
normalise sleep-wake cycle
ensure continuity of care
avoid urinary catheterisation and venflons
Pharmacological treatment of delirium
stop bad drugs eg anti cholinergics and sedatives
anti-psychotics
Dementia
Acquired decline in memory and other cognitive functions in an alert person sufficiently severe to cause functional impairment and present for >6 months
Main types of dementia
alzheimers lewy body dementia vascular dementia mixed dementia reversible causes
Alzhemiers characteristics
slow, insidious onset
loss of recent memory first
progressive functional decline
Risk factors for alzheimers
age
vascular risk factors
genetics
Vascular dementia characteristics
step wise deterioration
gait problems
executive function may predominate
Vascular risk factors
Type 2 DM, IHD,PVD,AF
Dementia with Lewy bodies characteristics
parkinsonism
very fluctuant
hallucinations common
falls common
Fronto-temporal characteristics
earlier age
early symptoms - behaviour change, language
lack of insight into memory problems
Diagnosing dementia
MMSE and MOCA
Problems with dementia tests
culture/generation/intellectual specific
falsely reassuring
Non pharmacological treatment of dementia
exercise environmental design cognitive stimulation avoiding change support for persons and carer advance care planning
Pharmacological treatment of dementia
cholinesterase inhibitors - Alzheimer and lewy body
anti-psychotics
Reversible causes of dementia
hypercalcaemia normal pressure hydrocephalus B12 deficiency hypo and hyperthyroidism intracerebral bleeds/tumours
Capacity - questions you should ask themselves?
person capable of making decisions about care
- capacity is decision specific
legally appointed proxy decision maker
MDT - dementia
social work psychiatrist geriatrician pharmacist OT HCSW physio nurse
