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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?

24
Q

What condition puts patients most at risk of developing delirium?

25
What might patient's family members say if the patient is developing delirium?
They're not themselves | This isn't like them
26
What drugs can commonly cause delirium?
Opioids | Anticholinergics
27
What test can be done to check for cognitive impairment?
Abbreviated mental state score
28
What score on the abbreviated mental state score indicates that cognitive impairment is likely?
Less than 7
29
What is delirium?
Acute confusional state
30
What are some of the key features of delirium?
``` Disorientated Confused Aggression/agitation Drowsiness Hallucinations Illusions Delusions ```
31
Who is most at risk of delirium?
Older frail patients
32
What is a leading cause of delirium?
Infection- especially UTI
33
What percentage of people in hospital develop delirium?
20% - this is thought to be the prevalence of delirium in hospital 1 in 5
34
Why is delirium worrying?
It accelerates cognitive decline in patients with dementia | It almost doubles the risk of death in patients with the same conditions
35
What is the key feature of delirium which you will need to ask family members or nursing staff about?
Is this an acute change?
36
What are the risk factors for developing delirium?
``` Pre-existing dementia/cognitive impairment Visual impairment Polypharmacy Multi-morbidity Frailty Elderly ```
37
What medication changes should you think about in patients with delirium?
Opiates Anticholinergics Sedation- benzodiazepines Withdrawal from medications
38
What acute illness can cause delirium?
Infection Shock Hypoxia
39
What metabolic abnormalities might cause delirium?
Hyponatraemia Hypercalcaemia Thyroid
40
What are some causes of delirium?
Use PINCH ME ``` Pain Infection Nutrition Constipation Hydration Medication Environment ```
41
How might the hospital environment cause delirium?
``` Loud Noise Disrupted sleep Unfamiliar Anxiety ```
42
What is the key cognitive deficit in delirium?
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
What measures could be employed to prevent delirium?
``` 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
What should be given if sedation is necessary?
Haloperidol 0.5mg IM/PO (Not IV) Titrate up to 3-5 mg if needed
45
Which conditions should haloperidol be avoided in?
Parkinson's Disease Lewy body dementia As the dopamine blockade worsens the symptoms

SPM- Elderly Medicine (6 decks)

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