Elderly Confusion Flashcards
what is confusion?
the act of confusing or the state of being confused
what are the 6 neurocognitive domains and subdomains in DSM5?
Complex attention perceptual motor function language function executive function learning/memory social cognition
according to DSM 5 what is complex attention
sustained attention
divide attention
selective attention
processing speed
according to DSM 5 what is perceptual motor function
visual perception
visuoconstructional reasoning
perceptual motor coordination
according to DSM 5 what is language function
object naming word finding fluency grammar and syntax receptive language
according to DSM 5 what is executive function
planning decision making working memory responding to feedback inhibition flexibility
according to DSM 5 what is learning/memory
free recall cued recall recognition memory semantic and autobiographical long-term memory implicit learning
according to DSM 5 what is social cognition
recognition of emotion
theory of mind
insight
why is assessing cognition important?
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
what key things must you identify when diagnosing cognitive impairment?
onset - when and how rapid
course - fluctuating, progressive decline
associated features - other illness, functional loss
key features of delirium
disturbed consciousness - hypo/hyperactive/mixed
change in cognition - memory/perceptual/language/illusions/hallucinations
acute onset and fluctuant
other common features of delirium
disturbance of sleep wake cycle
disturbed psychomotor behaviour
emotional disturbance
who gets delirium?
extremes of age
frailty - cognitive frailty, dementia, Parkinson’s
massive insult if young and fit
causes of delirium
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
what is the commonest complication of hospitalisation?
delirium
what are the complications of delirium?
increased risk of death
longer stay
increased rates of institutionalisation
persistent functional decline
briefly describe the 4AT tool
Alterness
AMT4 = age, DOB, place, current year
Attention = months backwards
Acute change or fluctuating cource
briefly describe the T in TIME bundle
NEWS BM Medication Hx - any changes Pain review - Abbey Pain Scale Urinary retention Constipation
briefly describe the I in TIME bundle
assess hydration and start fluid balance chart
bloods - FBC, U+E, Ca, LFTs, CRP, Mg, Glucose
look for symptoms/signs of infection
ECG
briefly describe the M in TIME bundle
initiate treatment of all underlying causes
briefly describe the E in TIME bundle
engage with patient, family and carers
explain diagnosis of delirium to patient, family and carers
document diagnosis of delirium
non-pharmacological measures in the treatment of delirium
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
what drugs are bad in delirium?
anticholinergics
sedatives
if a delirious patient becomes a danger to themselves or others what medication may you give them?
12.5mg quetiapine
define dementia
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
types of dementia
Alzheimer's Vascular Mixed Dementia with Lewy bodies fronto-temporal
describe Alzheimer’s dementia
slow, insidious onset
loss of recent memory first
progressive functional decline
risk factors for Alzheimer’s
age
vascular risk factors
genetics
describe vascular dementia
classically step-wise deterioration
executive dysfunction may predominate rather than memory impairment
associated with gait problems
what vascular risk factors are associated with vascular dementia?
T2DM
AF
IHD
PVD
describe dementia with lewy bodies
may have parkinsonism
often very fluctuant
hallucinations common - psychotic
falls common
if a person has recurrent delirium what diagnosis may you consider?
dementia with lewy bodies
describe fronto-temporal dementia
onset often young
early symptoms - behavioural change (aggression), language difficulties (aphasia, dysphasia), memory early on often not affected
lack of insight
what are some of the problems with tests for diagnosing dementia?
culturally/generationally/intellectually specific
can be falsely reassuring - screening and monitoring only
patient’s don’t care about score they want to function independently
non-pharmacological treatment of dementia
support for person and carers cognitive stimulation exercise environmental design - pictures avoiding changes in environment/social support advanced care planning
pharmacological treatment of dementia
cholinesterase inhibitors
antipsychotics
what cholinesterase inhibitor is licensed in mixed dementia?
galantamine
what cholinesterase inhibitor is licensed in lewy body dementia?
rivastigmine
what are reversible causes of dementia?
hypo/hyper thyroidism intracerebral bleeds/tumours B12 deficiency Hypercalcaemia normal pressure hydrocephalus depression
