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Systems: Specialities AB > Geriatics: Confusion > Flashcards

Geriatics: Confusion Flashcards

1
Q

What should we think about when we refer to someone as being confused?

A

Their cognitive ability

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2
Q

What are the 6 neurocognitive domains?

A
  • Complex attention
  • Perceptual-motor function
  • Language function
  • Executive function
  • Learning/memory
  • Social cognition
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3
Q

Why is assessing cognition important?

A
  • May be relevant to current medical problems
  • Associated with increased risk 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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4
Q

What is key in diagnosing cognitive impairment?

A

History

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5
Q

What is important to establish when taking a history in cognitive impairment?

A

Onset

  • When
  • How rapid

Course

  • Fluctuating?
  • Progressive decline

Associated features

  • Other illness
  • Functional loss
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6
Q

What are the key features of delirium?

A

Disturbed consciousness
-Hypoactive/hyperactive/mixed

Change in cognition
-Memory/perceptual/language/illusions/hallucinations

Acute onset and fluctuant

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7
Q

What features commonly occur in delirium

A
  • Disturbance of sleep wake cycle
  • Disturbed psychomotor behaviour
  • Emotional disturbance
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8
Q

What precipitates delirium?

A
  • Infection (but not always a UTI!)
  • Dehydration
  • Biochemical disturbance
  • Pain
  • Drugs
  • Constipation/Urinary retention
  • Hypoxia
  • Alcohol/drug withdrawal
  • Sleep disturbance
  • Brain injury
  • Change in environment
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9
Q

Why is it important to know about delirium?

A
  • Very common particularly in elderly
  • Commonest complication of hospitalisation
  • Massive morbidity and mortality
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10
Q

How is delirium diagnosed?

A

4AT score

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11
Q

What should you de when you diagnose delirium?

A
  • Explain the diagnosis

- Treat the cause (establish from history and exam, TIME bundle)

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12
Q

How should a patient with delirium be managed ?

A
  • Re-orientate and reassure agitated patients (USE FAMILIES/CARERS)
  • Encourage early mobility and self-care
  • Correction of sensory impairment
  • Normalise sleep-wake cycle
  • Ensure continuity of care (avoid frequent ward or room transfers)
  • Avoid urinary catheterisation/venflons
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13
Q

How should delirium be managed pharmacologically?

A
  • Drug treatment of delirium is usually not necessary
  • STOP BAD DRUGS (including anticholinergics and sedatives)
  • Sedatives should only be used if the patient is a danger to themselves or others or is severely distressed
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14
Q

What is dementia?

A

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

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15
Q

What are the types of dementia?

A
  • Alzheimers
  • Vascular dementia
  • Mixed Alzeimers/Vascular
  • Dementia with Lewy Bodies
  • ‘Reversible’ causes
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16
Q

How does Alzheimer’s present?

A
  • Slow, insidious onset
  • Loss of recent memory first
  • progressive functional decline
17
Q

What are the risk factors for Alzheimer’s?

A
  • Age
  • Vascular risk factors
  • Genetics
18
Q

How does vascular dementia present?

A
  • Classically step-wise deterioration
  • Executive dysfunction may predominate rather than memory impairment
  • Associated with gait problems often
19
Q

What are the risk factors for vascular dementia?

A

Often have known vascular risk factors

  • T2DM
  • AF
  • IHD
  • PVD
20
Q

How does dementia with Lewy bodies present?

A
  • May have parkinsonism
  • Often very fluctuant
  • Hallucinations common
  • Falls common
21
Q

How does fronto-temporal dementia present?

A

Onset usually earlier

Early symptoms differ from other dementias

  • Behavioural changes
  • Language difficulties
  • Memory is often unaffected early on

Usually lack insight into their difficulties

22
Q

How is dementia diagnosed?

A
  • MMSE
  • MOCA
  • History
23
Q

What are the problems with the tests used in the diagnosis of dementia?

A
  • Can be culturally/ generationally/ intellectually specific

- Can be falsely reassuring and should therefore be used as monitoring tools

24
Q

What non-pharmacological therapy is there for dementia?

A
  • Support for person and carers
  • Cognitive stimulation
  • Exercise
  • Environmental design
  • Avoiding changes in environment/social support etc
  • Advanced care planning
25
Q

What pharmacological forms of management is there for dementia?

A

Cholinesterase inhibitors

  • Mainly used in Alzheimer (Galantamine licensed in mixed dementia, Rivastigmine in Dementia with Lewy Bodies)
  • Not a cure

Anti-psychotics

  • Should be avoided If possible
  • Start low and go slow
26
Q

What reversible causes of dementia are there?

A
  • Hypothyroidism
  • Intracerebral bleeds/tumours
  • B12 deficiency
  • Hypercalcaemia
  • Normal pressure hydrocephalus
  • Depression
27
Q

What is capacity?

A

The capability of someone to make decisions about their care

28
Q

If someone does not have capacity, who may have the ability to make decisions for them?

A

Welfare POA or guardian

Systems: Specialities AB (19 decks)

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