Old age

Question 1

what are the three types of delirium ?

Answer 1

hyperactive
hypoactive
mixed

Question 2

what are DD for delirium?

Answer 2

alcohol/drug withdrawal
mania
post ictal 
anxiety 
psychosis 
dementia

Question 3

what are some causes of delirium ?

Answer 3

infection 
hypothermia 
post surgery 
medication 
electrolyte imbalance 
hypoglycaemia 
trauma 
withdrawal 
renal failure 
stroke

Question 4

what is the management for delirium?

Answer 4

treat underlying cause 
optimise supportive surroundings 
avoid sedation 
can give antipsychotic (haloperidol 1-10mg/24hr, olanzapine 2.5-10mg/24hr) and monitor BP 
regular clinic review

Question 5

state some ways to prevent delirium ?

Answer 5

avoid moving patients between or within wards
manage orientation by appropriate lighting, clocks
re-orientate patient
introduce stimulating activities
address hydration and nutritional needs
address immobility
carry out medication review
address sensory impairments
promote good sleep pattern and sleep hygiene

Question 6

what are the 4As of dementia?

Answer 6

amnesia
aphasia
agnosia
apraxia

Question 7

what investigations should be done for dementia ?

Answer 7

collateral Hx 
FBC 
B12/folate 
U&Es, LFT
Ca (renal failure, hepatic failure, alcoholism)
TSH
serology 
CT/MRI

Question 8

what medication can be used for dementia ?

Answer 8

acetylcholinesterase inhibitors
- donepezil, rivastigmine, galantamine

NMDA receptor antagonist
cations - increased creatinine, epilepsy, bradycardia with ACEI

Question 9

what tools can be used for dementia assessment?

Answer 9

MMSE
MOCA
ACER (addenbrookes cognitive examination revised)

Question 10

what can be tested to assess the frontal lobe?

Answer 10

frontal assessment battery (FAB)

similarities (conceptualisation)
lexical fluency (mental flexibility)
motor series (programming)
conflicting instructions (sensitivity to interference)
Go-No-Go (inhibiting control)
prehension behaviour (environmental autonomy)