Intellectual Impairment

Question 1

Describe the onset and course of delirium

Answer 1

Acute onset

Fluctuant course

Question 2

Give five clinical features associated with delirium

Answer 2

Disturbed consciousness (hypo- or hyper-active)
Change in cognition
Sleep-wake disturbance
Emotional disturbance (often very scared)
Delusions, paranoia

Question 3

Describe the possible triggers/causes of delirium

Answer 3

Infection e.g. UTI
Dehydration
Biochemical disturbance
Pain
Drugs
Hypoxia
Constipation, urine retention
Alcohol/drug withdrawal
Sleep disturbance
Brain injury
Stroke
Brain tumour

Question 4

Describe the onset and progression of dementia

Answer 4

Slow onset (at least six months)
Course; tends to be a progressive decline, but depends on the type of dementia
 - e.g. stepwise progression in vascular dementia

Question 5

Give three clinical features associated with dementia with Lewy Bodies

Answer 5

Movement problems (similar to Parkinson’s)
Hallucinations (friendly)
Falls

Question 6

Describe the management options for Delirium

Answer 6

***Treat the underlying cause!

History/examination
Stop any drugs that are unnecessary and/or potentially harmful
Reorientate and reassure 
Normalise the sleep/wake cycle
Ensure continuity of care
Avoid catheters

Drug treatment may be used occasionally

Question 7

Which drug can be used in specific cases of delirium?

Answer 7

Quetiapine (12.5mg)

Question 8

Describe the pharmacological management options for dementia

Answer 8

Cholinesterase inhibitors
- Galantamine
- Rivastigmine
Antipsychotics (used occasionally but avoid if possible!)

Question 9

Describe the non-pharmacological management options for dementia

Answer 9

Support (for both patient and carer)
Exercise
Cognitive stimulation
Environmental design

Question 10

Name two drugs sedatives which may be used (as a last resort) in a delirius patient.

Answer 10

Haloperidol

Lorazepam

Question 11

Describe the initial assessment of a confused patient

Answer 11

ABC assessment
Are they orientated to place, time and person?
 - AMTS or MMSE
Can they follow a 3-step command? 
 - test for receptive dysphasia
Can they name three common objects?
 - test for expressive dysphasia
Ask/examine for other symptoms, especially pain

Question 12

Which drugs can cause confusion/delirium?

Answer 12

diuretics
digoxin
anticholinergics
thyroid medications
alcohol (and alcohol withdrawal)
opiates
antipsychotics, tricyclic antidepressants
lithium
beta-blockers
antihistamines