Geriatics: Confusion Flashcards
1
Q
What should we think about when we refer to someone as being confused?
A
Their cognitive ability
2
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
3
Q
What precipitates delirium?
A
- Infection (but not always a UTI!)
- Dehydration
- Pain
- Drugs
- Constipation/Urinary retention
- Change in environment
4
Q
How is delirium diagnosed?
A
4AT score
5
Q
How should a patient with delirium be managed ?
A
- Re-orientate and reassure agitated patients (use families)
- Encourage early mobility and self-care
- Correction of sensory impairment
- Normalise sleep-wake cycle
- Avoid urinary catheterisation/venflons
6
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
7
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.
8
Q
What are the types of dementia?
A
- Alzheimers
- Vascular dementia
- Mixed Alzeimers/Vascular
- Dementia with Lewy Bodies
- ‘Reversible’ causes
9
Q
How does Alzheimer’s present?
A
- Slow, insidious onset
- Loss of recent memory first
- Progressive functional decline
10
Q
What are the risk factors for Alzheimer’s?
A
- Age
- Vascular risk factors
- Genetics
11
Q
How does vascular dementia present?
A
- Classically step-wise deterioration
- Executive dysfunction may predominate rather than memory impairment
- Associated with gait problems often
12
Q
What are the risk factors for vascular dementia?
A
Often have known vascular risk factors
- type 2 diabetes mellitus
- atrial fibrillation
- ischaemic heart disease
- peripheral vascular disease
13
Q
How does dementia with Lewy bodies present?
A
- May have parkinsonism
- Often very fluctuant
- Hallucinations common
- Falls common
14
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
15
Q
How is dementia diagnosed?
A
- MMSE
- MOCA
- History
