Geriatric Confusion

Question 1

What are the key features of delirium?

Answer 1

Disturbed consciousness
Change in cognition (memory, perceptual, language, illusions, hallucinations)
Acute onset and fluctuations

Question 2

What are some other features of delirium?

Answer 2

Disturbance of sleep wake cycle
Disturbed psychomotor behaviour
Emotional disturbance
Delusions

Question 3

What can precipitate delirium?

Answer 3

Infection (especially UTI) 
Dehydration 
Biochemical disturbance 
Pain 
Drugs 
Constipation/ urinary retention 
Hypoxia 
Alcohol/ drug withdrawal 
Sleep disturbance 
Brain injury

Question 4

What are the non-pharmacological treatment options for delirium?

Answer 4

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

Question 5

What can be used to diagnose delirium?

Answer 5

4AT score

Question 6

What is dementia?

Answer 6

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

Question 7

What are the different types of dementia?

Answer 7

Alzheimer's disease 
Vascular dementia 
Mixed Alzheimer's/vascular 
Dementia with Lewy Bodies 
'Reversible' causes

Question 8

What are the risk factors for Alzheimer’s?

Answer 8

Age
Vascular risk factors
Genetics

Question 9

What are the key features of Alzheimer’s?

Answer 9

Slow, insidious onset
Loss of recent memory first
Progressive functional decline

Question 10

What are the risk factors for vascular dementia?

Answer 10

Type 2 diabetes
Atrial fibrillation
Ischaemic heart disease
PVD

Question 11

What are the key features of vascular dementia?

Answer 11

Classically step-wise deterioration
Executive dysfunction may predominate
Associated with gait problems often

Question 12

What are the key features of dementia with lewy bodies?

Answer 12

Link with Parkinson’s disease
Often very fluctuant
Hallucinations common
Falls common

Question 13

What are the symptoms of fronts-temporal dementia?

Answer 13

Behavioural change
Language difficulties
Memory early on often not affected
Usually lack insight into difficulties

Question 14

What is the non-pharmacological therapy of dementia?

Answer 14

Support for person or carers 
Cognitive stimualtion
Exercise 
Environmental design 
Music/light therapy 
reality orientation therapy

Question 15

What are the main pharmacological treatments for dementia?

Answer 15

Cholinesterase inhibitors

Anti-psychotics

Question 16

What are some examples of cholinesterase inhibitors?

Answer 16

Galantamine in mixed dementia

Rivatigmine in dementia with lewy bodies

Question 17

What are the possible ‘reversible’ causes of dementia?

Answer 17

Hypothyroidism 
Intracerebral bleeds/tumours 
B12 deficiency 
Hypercalcaemia 
Normal pressure hydrocephalus 
Depression