Elderly- Delirium

Question 1

What is Delirium?

Answer 1

An acute and fluctuating disturbance in level of consciousness, attention and global cognition.

Question 2

What is required with delirium to prevent brain damage?

Answer 2

Prompt treatment

Question 3

What are the main features of delirium?

Answer 3

Acute onset and fluctuant
Disturbed consciousness
Change in cognition-

Question 4

How is cognition disturbed with delirium?

Answer 4

It can be
• Hypoactive
• Hyperactive
• Mixed

Question 5

What changes in cognition can be seen with delirium?

Answer 5

• Memory
• Perceptual
• Language
• Illusions
• Hallucinations

Question 6

What are other common features seen with delirium?

Answer 6

• Disturbance of sleep wake cycle
• Disturbed psychomotor behaviour –Affects physical function
• Emotional disturbance

Question 7

What are the psychiatric symptoms of delirium?

Answer 7

• Disorientation (time/place/person);
• Inattention;
• illusions/hallucinations;
• Altered personality;
• Mood disorders;

Question 8

How do delirium symptoms present?

Answer 8

Fluctuate over the course of the day and tend to be worse at night.

Question 9

What are possible CNS causes of delirium?

Answer 9

• Stroke
• Abscess
• Tumour
• Subdural haematoma

Question 10

What are some drug or withdrawal causes of delirium?

Answer 10

• Anticholinergics
• Antiemetics
• Antipsychotics
• Alcohol

Question 11

What are some endocrine causes of delirium?

Answer 11

• Hyperparatyroidism

* hyper/hypothyroidism

Question 12

What infections can cause delirium?

Answer 12

• Encephalitis
• Meningitis
• Pneumonia
• Sepsis
• UTI

Question 13

What are other possible causes of delirium?

Answer 13

• Sleep depravation
• Constipation/Urinary retention
• Dehydration

Question 14

What is done as soon as someone starts to present with delirium?

Answer 14

4AT

Question 15

Why would you do a collateral history on someone presenting with Delirium?

Answer 15

To determine if the changes in mental status are recent and the patients normal level of functioning.

Question 16

What is done to diagnose delirium?

Answer 16

CAM-Confusion Assessment Method (CAM)

Question 17

Which features does CAM state are diagnostic?

Answer 17

• Acute change in cognition which fluctuates during the day;
• Inattention;
• Disturbance of consciousness;
• Disorganised thinking.

Question 18

What else should be done when a patient presents with delirium?

Answer 18

Drug history and alcohol history
A mini-mental state examination- deficits in attention
Examined for potential signs of infection

Question 19

What is the difference in onset between delirium and dementia?

Answer 19

Delirium has sudden onset and fluctuating course over days – weeks

Dementia has a • Gradual onset, slowly progressive over months – years

Question 20

How is consciousness impacted in delirium vs dementia?

Answer 20

In delirium, there is Variation in level of consciousness

In dementia, consciousness is unimpaired

Question 21

How is attention affected in delirium vs dementia?

Answer 21

In delirium, there is impaired attention

In dementia, attention is preserved

Question 22

What type of changes do you tend to see with delirium?

Answer 22

Psychomotor changes

Question 23

What is the first step in the management of delirium?

Answer 23

Treat the underlying cause or removing aggravating drugs

Question 24

What is the environmental management of delirium?

Answer 24

Nurse patients in a quiet and well-lit room.

Minimise sensory deficits

Question 25

Why is it important to discharge a patient ASAP?

Question 26

What medical management can be used for agitation?

Answer 26

• Haloperidol (0.5-1.0mg PO)

* Lorazepam (0.5-1.0mg PO)

Question 27

Why should you avoid giving medical management for agitation?

Answer 27

It may worsen or prolong the delirium

Question 28

What is 4AT?

Answer 28

screening instrument designed for rapid initial assessment of delirium and cognitive impairment.