[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- quiet and withdrawn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
delirium vs dementia vs depression: fluctuation
delirium - yes
dementia - no (except Lewy Body)
depression - no
delirium vs dementia vs depression: reversible
delirium - yes, recovery may take several months
dementia - no
depression - yes
delirium vs dementia vs depression: treatment
delirium - treat underlying cause
dementia - acetylcholinesterase inhibitors or memantine
depression - antidepressants
delirium vs dementia vs depression: legal framework to treat if unable to consent/risk
delirium - Mental Capacity Act
dementia - Mental Capacity Act, Mental Health Act
depression - Mental Health Act
visual hallucinations + macular degeneration. dx?
Charles Bonnett syndrome
Parkinsonism, visual hallucinations and memory impairment. dx?
Lewy-Body dementia
deranged LFTs, asterixis and confusion. dx?
hepatic encephalopathy
what are the precipitating causes of delirium?
DELIRIUM:
D - drugs, dehydration, detox, deficiencies, discomfort (pain)
E - electrolytes, elimination abnormalities, environment
L - lungs (hypoxia), liver, lack of sleep, long ED stay
I - infection, iatrogenic events, infarction (cardiac, cerebral)
R - restraints, restricted movement/mobility, renal failure
I - injury, impaired sensory input, intoxication
U - UTI, unfamiliar environment
M - metabolic abnormalities (glucose, thyroid), metastasis (brain), medications
