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SPM- Elderly Medicine > LO2- Assessment of cognition in people > Flashcards

LO2- Assessment of cognition in people Flashcards

1
Q

What is delirium?

A

An acute decline in cognitive function and consciousness

Often precipitated by an acute illness

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2
Q

What are some causes of delirium?

A 
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment
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3
Q

How can features of delirium be divided?

A

Hyperactivity and Agitation

Hypoactivity and Drowsiness

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4
Q

What differentiates delirium from psychiatric disorders such as dementia?

A

Delirium is an acute change in cognitive function
Dementia and psychiatric disorders tend to present with a gradual decline over months to years
Disorientation is an early feature of delirium but a late feature of demetnion
Delirium is transient

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5
Q

What is one of the earliest signs of delirium?

A

Inattention or difficulty focussing

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6
Q

What are some symptoms of hyperactive delirium?

A

Disorientated
Confused
Agitation/Aggression

Perceptual Disorders and disorganised thoughts:
Hallucinations
Illusions
Delusions

Worsening of symptoms at night

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7
Q

What is meant by sundown?

A

This is when delirium symptoms worsen at night

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8
Q

What are the features of hypoactive delirium?

A

Withdrawal
Drowsiness
Confusion

(May be a mixed state with both hyperactive and hypoactive)

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9
Q

What test can be used to screen for delirium?

A

4AT

Alertness
AMT4- Age, Date, place, current year
Attention
Acute change of fluctuating course

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10
Q

What are the components of the 4AT screening test for delirium?

A

Alertness
AMT4
Attention
Acute Chagne

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11
Q

What can individual score for the alertness section of the 4AT screening tool?

A 
0= Normal
0= Mild sleepiness for <10 seconds after waking then normal
4= Abnormal

Note abnormal may be not allerto or agitated or hyperactive

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12
Q

What is asked about in the AMT4 section of 4AT assessment?

A

Ask the person their age, DOB, place and current year

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13
Q

What do people score for the AMT4 section of 4AT?

A

No mistakes = 0
1 Mistake = 1
2 Mistakes= 2

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14
Q

What is asked about in the AMT4 section of 4AT?

A

Age
DOB
Place
Current year

A point is given for each mistake up to 2

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15
Q

What are the four sections of the 4 AT assessment?

A

Alertness
AMT4- Age, DOB, Place, Current Year
Attention
Acute or fluctuating course

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16
Q

What can you ask a patient to do to check their attention in this section of the 4AT assessment?

A

Recalls the months of the year backwards from december

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17
Q

What can be scored for the attention section of the 4AT assessment?

A

The patient is asked to recall the months of the year backwards from december

7 or more= 0 points
Starts but scores <7/ refuses to start = 1 point
Untestable (unwell, drowsy, inattentive)= 2 points

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18
Q

What are the four components of the 4AT assessment, and what is the most that can be scored in each section?

A

Alertness - Max 4
AMT4- Max 2
Attention- Max 4
Acute Change- Max 4 (If present)

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19
Q

What is the most an individual can sore for the acute change section?

A

4 if there is an acute change in cognitive function

This is evidence of a change in: alertness, cognition, paranoia, hallucinations

20
Q

What score on the 4AT test indicates that delirium may be likely?

A

A score of 4 or more

Note- 1-3 is possible delirium

21
Q

What is asked about in the abbreviated mental test score (AMTS)?

A 
Time of day to the nearest hour
Year
Place
Identity of two people
Age
DOB
Address to be remembered- 42 West Street
Name of monarch
Year of the start of first world war
Count back from 20 to 1

A point is given for each correct answer.

Address is said, ask to repeat and then recall after 5 minutes?

<7 is a marker of cognitive impairment

22
Q

Which members of the MDT are really good at cognition assessments?

A

Occupational therapists

23
Q

What is the most common post surgical complication seen in older people?

A

Delirium

24
Q

What condition puts patients most at risk of developing delirium?

A

Dementia

25
Q

What might patient’s family members say if the patient is developing delirium?

A

They’re not themselves

This isn’t like them

26
Q

What drugs can commonly cause delirium?

A

Opioids

Anticholinergics

27
Q

What test can be done to check for cognitive impairment?

A

Abbreviated mental state score

28
Q

What score on the abbreviated mental state score indicates that cognitive impairment is likely?

A

Less than 7

29
Q

What is delirium?

A

Acute confusional state

30
Q

What are some of the key features of delirium?

A 
Disorientated
Confused
Aggression/agitation
Drowsiness
Hallucinations
Illusions
Delusions
31
Q

Who is most at risk of delirium?

A

Older frail patients

32
Q

What is a leading cause of delirium?

A

Infection- especially UTI

33
Q

What percentage of people in hospital develop delirium?

A

20% - this is thought to be the prevalence of delirium in hospital

1 in 5

34
Q

Why is delirium worrying?

A

It accelerates cognitive decline in patients with dementia

It almost doubles the risk of death in patients with the same conditions

35
Q

What is the key feature of delirium which you will need to ask family members or nursing staff about?

A

Is this an acute change?

36
Q

What are the risk factors for developing delirium?

A 
Pre-existing dementia/cognitive impairment
Visual impairment
Polypharmacy
Multi-morbidity
Frailty
Elderly
37
Q

What medication changes should you think about in patients with delirium?

A

Opiates
Anticholinergics
Sedation- benzodiazepines
Withdrawal from medications

38
Q

What acute illness can cause delirium?

A

Infection
Shock
Hypoxia

39
Q

What metabolic abnormalities might cause delirium?

A

Hyponatraemia
Hypercalcaemia
Thyroid

40
Q

What are some causes of delirium?

A

Use PINCH ME

Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment
41
Q

How might the hospital environment cause delirium?

A 
Loud
Noise
Disrupted sleep
Unfamiliar 
Anxiety
42
Q

What is the key cognitive deficit in delirium?

A

Attentional defect- this is tested with asking the patient to recall the months of the year backwards

7 or more = 0
Less than 7 or refuses to do it = 1
Can’t do it= 2

43
Q

What measures could be employed to prevent delirium?

A 
Hearing aids
Making sure glasses are available
Avoid changing environment
Quiet environment 
Keep hydrated
Stop unnecessary medications
Avoid catheterising or cannulating people if not needed
Monitor bowel opening 
Family/friends visiting

If a cause is known- treat this

44
Q

What should be given if sedation is necessary?

A

Haloperidol 0.5mg IM/PO (Not IV) Titrate up to 3-5 mg if needed

45
Q

Which conditions should haloperidol be avoided in?

A

Parkinson’s Disease
Lewy body dementia

As the dopamine blockade worsens the symptoms

SPM- Elderly Medicine (6 decks)

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