The Most Basic Delirium Recap Ever

Question 1

what are the three subtypes of delirium?

Answer 1

hyperactive, hypoactive, mixed

mixed MC

Question 2

what percentage of patients with baseline dementia experience delirium in the hospital?

Answer 2

65 percent

Question 3

what percentage of geriatric patients will have an episode of delirium prior to death?

Answer 3

83 percent

Question 4

what is the one year mortality rate of an episode of delirium?

Answer 4

35-40 percent

Question 5

is delirium associated with underlying dementia?

Answer 5

YES; strongly

Question 6

what brain structure is thought to contribute to hyperarousal and sensory overload in patients with delirium?

Answer 6

thalamus

Question 7

delirium is thought to be a disruption in neurotransmitters. do we have a deficiency or increase in cholinergic activity? how about dopamine?

Answer 7

cholinergic deficiency (hence why anticholinergics make delirium worse)

excess dopamine (hence why antipsychotics help)

Question 8

what percentage of delirious patients are demented?

Answer 8

25 percent

Question 9

_____ can lead to increased pain perception, diminished concentration, increased sympathetic tone

Answer 9

sleep deprivation

Question 10

what is the most prevalent predisposing factor for delirium? how about the most important precipitating factor?

Answer 10

MC predisposing = 3+ comorbid conditions

MC precipitating: 3+ new drugs (polypharmacy)

Question 11

cognitive impairment at baseline, restraints, and sensory deprivation (vision) are the three risk factors for what?

Answer 11

prolonged delirium

Question 12

hyperactived/mixed delirium is often due to which events?

Answer 12

1) cholinergic toxicity
2) serotonin syndrome
3) stimulant toxicity
4) ETOH/benzo withdrawal

Question 13

hypoactive delirium is often due to which types of drugs and things?

Answer 13

benzos

narcotic overdose

sedatives/hypnotics/ETOH

Question 14

are atypical antipsychotics (seroquel) better than typical antipsychotics (haldol) in delirium?

Answer 14

NOooo

haldol and risperidone best

Question 15

what is the CAM? what does it entail?

Answer 15

confusion assessment model

1) acute change and fluctuation in mental status and behavior AND
2) inattention AND EITHER
3) disorganized thinking OR
4) altered consciousness (hypervigilant vs. hypoarousal, etc)

Question 16

is the CAM alone enough to DX delirium?

Answer 16

no, do after MMSE

also do with tests of attention

Question 17

picture recall, spelling “world” backwards, days of week/months backwards are examples of what?

Answer 17

tests of attention

Question 18

characterized by a rapid onset, a defect in attention, fluctuating during the course of a day

Answer 18

delirium

Question 19

are visual hallucinations common in delirium?

Answer 19

yes

Question 20

characterized by an insidious onset, primarily a defect in short term memory, with often NORMAL attention that does NOT fluctuate during the day

Answer 20

dementia

Question 21

which group is able to attend to a MMSE and clock draw, delirium or dementia?

Answer 21

dementia!

they can attend to it, but cannot perform it well

delirium can’t attend to it

Question 22

what are the two hallmarks of lewy-body dementia? how do we treat?

Answer 22

fluctuating changes (less abrupt than delirium) and well formed visual hallucinations

treat with seroquel

Question 23

what is the mnemonic for causes of delirum?

Answer 23

DELIRIUMS + P

1) Drugs, toxins
2) Eyes, ears (sensory deprivation)
3) Low O2 sats (MI, ARDS, PE, COPD, shock, stroke)
4) Infection
5) retention of urine/stool, restraints
6) Ictal (post) serizure
7) Underhydration, undernutrition
8) Metabolic (hypo/hyperglycemia, calcemia, uremia, liver failure, thyroid disorders)
9) Sleep deprivation, oversedation, stroke
10) P for pain

Question 24

a study was performed on different interventions to reduce delirium. which two interventions were proven to lower risk of delirium the most?

Answer 24

cognition (orientation, activities) and sleep deprivation!

Question 25

are there any drugs labeled for delirium on the market?

Answer 25

NO, all off label

Question 26

by what percentage may we reduce delirium events if we consider early intervention protocol?

Answer 26

40 percent

things like hearing aids, visual aids, ambulation, exercise, bedtime routines, activities, volume replacement if dehydrated

Question 27

why do we worry about prescribing neuroleptics in people with delirium?

Answer 27

black box warning for death in people with dementia!

Question 28

should we give benzos to calm down our agitated delirious patient?

Answer 28

NO

Question 29

we should avoid typical antipsychotics in ______

Answer 29

parkinsons and lewy body dementia