Week 4 - A - Delilirum assessment tests - 4A.T and C.A.M, Dementia assessment tests - M.M.S.E, M.o.C.A, Addenbrookes Flashcards
What is the most common mental health problem in patients aged over 65?
Delirium
How is delirium defined?
- Acute onset of mental status change +
- inattention with fluctuating course plus one of
- disorganized thinking or
- altered state of consciousness
What abnormalities would be seen in delirium in perception?
They are likely to have hallucinations particularly visual hallucinations
What are the three different types of delirium?
- * Hyperactive/hyperagitated
- * Hypoactive/hypoagitated
- * Mixed - fluctuating symptoms
Hyperalert/Hyperactive
- * Agitation, disorientation, hallucinations and delusions, sometimes aggressive
Hypoalert/Hypoactive
- * Confusion, sedation
Mixed
- * Fluctuating symptoms of both types
What can hypoactive delirium often be misdiagnosed as?
Can often be misdiagnosed as depression
Also if delirium is in the elderly, can be misdiagnosed as dementia but have to remember that delirium has acute onset
If a patient with delirium becomes a risk of harm to others or themselves, what can be prescribed? What do you give if the patient has DLB or DPD? What do you give if patient is experiencing alcohol or benzo withdrawal symtpoms? can help prevent delirium tremens from occuring?
First line delirium option is to give haloperidol oral (IM if needed)
If the patient has lewy body dementia or parkinsons - give lorazepam 1st line (quetiapine can be given but takes longer to act so usually second line)
What is given to a patient who is experiencing the symptoms of alcohol / benzo withdrawal? What is given if this progresses to derlirium tremens and patients needs to be sedated?
Experiencing symptoms of due benzo or alcohol withdrawal - give a long acting benzo ie diazepam or chlordizaepoxide
If delirium tremens give lorazepam 1st line (quick acting benzo) (same as in lewy body dementia / parkinsons)
What is the rapid assessment test for delirium known as?
This is the 4AT
What are the different section of the 4AT?
Alertness AMT-4 (abbreviated mental test 4) - age, DOB, current place, year
Attention - the months backwards
Acute change or fluctuating course
Delirium - acute change + inattention with fluctuating course plus one of disorganized thinking or altered level of consciousness
WHat score on the 4AT is indicative of delirium?
Score of 4 and above is possible delirium and/or cognitive impairment
What is the tool that is used to diagnose delirium?
Confusion assessment method - usually a postgraduate method so needs training to use
4AT provides the rapid assessment for dleirium
SIGN GUIDLEINES “In individuals with suspected cognitive impairment, the MMSE should be used in the diagnosis of dementia.” “Initial cognitive testing can be improved by the use of the Addenbrookes Cognitive Examination”. What is the mini mental state examination? What is mild and what is severe cognitive impairment in this test?
Mini mental state examination
A test to look for any signs of cogntiive impairment in a patient suspected of dementia - total score is out of 30
24-30 - no cognitive impairment
18-23 - mild cognitive impairment
<17 - severe cognitive impairment
Why is the mini mental state not really used anymore? What is the test that is now used far more as it is not under the same restrictions?
The mini mental state examination is not really used anymore due to being under copyright charges
The MoCA (montreal cognitive assessment) is the main rapid screening tool that is used to look for cognitive dysfunction
Assesses multiple cognitive domains
Freely available/no copyright
What score on the MoCA would indicate cognitive impairment? What can be carried out if this is the score?
The total possible score is 30 points;
a score of 26 or above is considered normal.
<26 is considered to be cognitive impairment
If the score is <26, carry out an addenbrookes cognitive examination III
