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Year 3 > Elderly Confusion > Flashcards

Elderly Confusion Flashcards

1
Q

what is confusion?

A

the act of confusing or the state of being confused

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2
Q

what are the 6 neurocognitive domains and subdomains in DSM5?

A 
Complex attention
perceptual motor function
language function
executive function
learning/memory
social cognition
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3
Q

according to DSM 5 what is complex attention

A

sustained attention
divide attention
selective attention
processing speed

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4
Q

according to DSM 5 what is perceptual motor function

A

visual perception
visuoconstructional reasoning
perceptual motor coordination

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5
Q

according to DSM 5 what is language function

A 
object naming
word finding
fluency
grammar and syntax
receptive language
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6
Q

according to DSM 5 what is executive function

A 
planning
decision making
working memory
responding to feedback 
inhibition
flexibility
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7
Q

according to DSM 5 what is learning/memory

A 
free recall
cued recall
recognition memory
semantic and autobiographical long-term memory
implicit learning
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8
Q

according to DSM 5 what is social cognition

A

recognition of emotion
theory of mind
insight

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9
Q

why is assessing cognition important?

A

may be relevant to current medical problems
associated with increased risk of death/increased LOS/discharge to care home
may need to alter communication/information given/involvement of family members
help you decide regarding capacity
may alter appropriateness of tests/investigations/certain treatments
may be able to improve it

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10
Q

what key things must you identify when diagnosing cognitive impairment?

A

onset - when and how rapid
course - fluctuating, progressive decline
associated features - other illness, functional loss

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11
Q

key features of delirium

A

disturbed consciousness - hypo/hyperactive/mixed
change in cognition - memory/perceptual/language/illusions/hallucinations
acute onset and fluctuant

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12
Q

other common features of delirium

A

disturbance of sleep wake cycle
disturbed psychomotor behaviour
emotional disturbance

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13
Q

who gets delirium?

A

extremes of age
frailty - cognitive frailty, dementia, Parkinson’s
massive insult if young and fit

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14
Q

causes of delirium

A 
infection
dehydration
biochemical disturbance - high and low Na,K, high Ca
pain
drugs - indirect - ACEI, NSAIDS resulting in AKI
constipation/urinary retention
hypoxia
alcohol/drug withdrawal
sleep disturbance
brain injury
changes in environment - carers, respite
multiple triggers
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15
Q

what is the commonest complication of hospitalisation?

A

delirium

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16
Q

what are the complications of delirium?

A

increased risk of death
longer stay
increased rates of institutionalisation
persistent functional decline

17
Q

briefly describe the 4AT tool

A

Alterness
AMT4 = age, DOB, place, current year
Attention = months backwards
Acute change or fluctuating cource

18
Q

briefly describe the T in TIME bundle

A 
NEWS
BM
Medication Hx - any changes
Pain review - Abbey Pain Scale
Urinary retention
Constipation
19
Q

briefly describe the I in TIME bundle

A

assess hydration and start fluid balance chart
bloods - FBC, U+E, Ca, LFTs, CRP, Mg, Glucose
look for symptoms/signs of infection
ECG

20
Q

briefly describe the M in TIME bundle

A

initiate treatment of all underlying causes

21
Q

briefly describe the E in TIME bundle

A

engage with patient, family and carers
explain diagnosis of delirium to patient, family and carers
document diagnosis of delirium

22
Q

non-pharmacological measures in the treatment of delirium

A

reorientate and reassure agitated patients - families, reintroduce, explain
encourage early mobility and self-care
correction of sensory impairment
normalise sleep- wake cycle
ensure continuity of care - avoid ward and room transfers
avoid urinary catheters and venflons

23
Q

what drugs are bad in delirium?

A

anticholinergics

sedatives

24
Q

if a delirious patient becomes a danger to themselves or others what medication may you give them?

A

12.5mg quetiapine

25
Q

define dementia

A

an acquired decline in memory and other cognitive functions in an alert person sufficiently severe to cause functional impairment and present for more than 6 months

26
Q

types of dementia

A 
Alzheimer's
Vascular
Mixed
Dementia with Lewy bodies
fronto-temporal
27
Q

describe Alzheimer’s dementia

A

slow, insidious onset
loss of recent memory first
progressive functional decline

28
Q

risk factors for Alzheimer’s

A

age
vascular risk factors
genetics

29
Q

describe vascular dementia

A

classically step-wise deterioration
executive dysfunction may predominate rather than memory impairment
associated with gait problems

30
Q

what vascular risk factors are associated with vascular dementia?

A

T2DM
AF
IHD
PVD

31
Q

describe dementia with lewy bodies

A

may have parkinsonism
often very fluctuant
hallucinations common - psychotic
falls common

32
Q

if a person has recurrent delirium what diagnosis may you consider?

A

dementia with lewy bodies

33
Q

describe fronto-temporal dementia

A

onset often young
early symptoms - behavioural change (aggression), language difficulties (aphasia, dysphasia), memory early on often not affected
lack of insight

34
Q

what are some of the problems with tests for diagnosing dementia?

A

culturally/generationally/intellectually specific
can be falsely reassuring - screening and monitoring only
patient’s don’t care about score they want to function independently

35
Q

non-pharmacological treatment of dementia

A 
support for person and carers
cognitive stimulation
exercise
environmental design - pictures
avoiding changes in environment/social support
advanced care planning
36
Q

pharmacological treatment of dementia

A

cholinesterase inhibitors

antipsychotics

37
Q

what cholinesterase inhibitor is licensed in mixed dementia?

A

galantamine

38
Q

what cholinesterase inhibitor is licensed in lewy body dementia?

A

rivastigmine

39
Q

what are reversible causes of dementia?

A 
hypo/hyper thyroidism
intracerebral bleeds/tumours
B12 deficiency
Hypercalcaemia
normal pressure hydrocephalus
depression

Year 3 (164 decks)

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