86b - Delirium

Question 1

What is required to diagnose delirium?

Answer 1

• Disturbance in attention and awareness
• Develops over a short period of time and fluctuates
• Additional disturbance in cognition
  
  • ​Memory, languaguage, visuospatial, or perception
• Evidence that the disrubance is caused by direct physiological consequences of another condition
  
  • Medical, substance, toxin, etc

Question 2

How does delirium affect slee?

Answer 2

Disrupts architecture

No deep or REM sleep

Question 3

What is the cognitive trajectory after delirium?

Answer 3

Ongoing cognitive impairments

• Average is 1.5 SD below the population mean
  
  • Equivalant to mild TBI
• 26% are 2.0 SD below the population mean
  
  • Equivalent to mild Alzheimer’s Disease

Question 4

What 3 characteristics predispose a person to delirium?

Answer 4

• Increased age
• Cognitive impairment
• Frailty

Question 5

How will a patient with delirium present differently from a patient with dementia?

Answer 5

A delerious patient will have…

• Faster onset of symptoms
• Shorter duration of symptoms
• Fluctuating symtoms
  
  • vs. dementia will be stable
• Reduced awareness and alertness
  
  • vs. dementia will be unchanged
• More changes in speech

Question 6

How do you treat delirium?

Answer 6

Address underlying cause

Haloperidol can be used for psychosis (avoid in pts with long QT)

Supportive treatment for symptoms of delirium

• Fluids
• Sleep/wake intervention
• Orientation aids
• No restraints!!
• Ambulation and mobility
• Cognitive stimulation

Question 7

Which antipsychotic is used to treat delirium? In which patients should it be avoided?

Answer 7

Haloperidol

• Avoid in pts with long QT syndrome

Question 8

Which medications might be used for delirium prophylaxis?

Answer 8

Olanzapine and ramelteon

• But these are still being studied