[Geriatrics] Confusion Flashcards
what is delirium?
an acute confusional state
what is delirium characterised by?
- disturbances in consciousness, cognitive function or perception
- acute in onset with a fluctuating course
what is essential in assessing delirium?
collateral hx
pts with predisposing factors are at an increased risk of developing delirium. what are the predisposing risk factors?
- older age (>65 years)
- cognitive impairment
- frailty / multiple co-morbidities
- significant injuries e.g. hip fracture
- functional impairment
- iatrogenic (surgery, medications, catheterisation)
- sensory impairment
- poor nutritional status
- lack of stimulation
- terminal illness
- alcohol intoxication / withdrawal
causes of delirium are often…?
multifactorial
delirium is associated with…?
significant morbidity and mortality
how may delirium present as?
- hypoactive
- hyperactive
- mixed
what are features of hypoactive delirium?
- lethargy
- reduced movement
- lack of interest in daily activities
- quiet and withdrawn
if severe, can cause a reduced GCS
what are features of hyperactive delirium?
- increased sensitivity to surroundings
- agitation
- restlessness
- sleep disturbance
- hyper-vigilance
what are features of mixed delirium?
combination of hyper and hypoactive delirium
how is a Dx of delirium made?
based on DSM-IV or the short Confusion Assessment Method (short-CAM)
what is the DSM IV criteria for diagnosing delirium?
need all 4 of:
- confusion which is new and fluctuating
- altered consciousness
- change in cognition
- evidence from hx/ex/ix which cannot be attributed to another condition
what is the short-CAM criteria for diagnosing delirium?
need 1+2+3/4:
- confusion which is new and fluctuating
- inattention
- disorganised thinking
- altered consciousness
delirium vs dementia vs depression: consciousness
delirium - altered
dementia - normal
depression - normal
delirium vs dementia vs depression: onset
delirium - acute
dementia - chronic
depression - chronic
