Delirium Flashcards
What is delirium
What is it characterized by
What are the common causes
What are the consequences of delirium on dementia
Acute brain failure
- Within hours/days and fluctuates
- impaired attention, awareness
- cognitive neuropsych issues (decreased Ach or increased D)
GENERALLY MULTIFACTORIAL Dehydration Electrolytes Level of pain Inflammation, infection Resp failure Impacted faeces Urinary retention MI/metabolic acidosis
Delirium increases dementia progression
What are the 3 forms of delirium
Hyperactive
- increased confusion
- hallucinations
- disturbed sleep
- less cooperative
- restless, agitation
Hypoactive
- decreased concentration
- decreased awareness
- decreased movement
- decreased appetite
- withdrawn, quiet, sleepy
Mixed, can move between the 2
How would you do the CAM (confusion assessment method)
- Acute and fluctuating
- Inattention
- Disorganized thinking
- Hypo/hyperalert
1&2 + 3/4
How would you assess if the delirium is acute and fluctuating in the CAM
Change from baseline
Collateral Hx (have they been more confused lately over the past few hours/days?)
How would you assess inattention in the CAM
Vague, non committant responses
Easily distracted
-months of the year forwards and backwards
-20=>1 counting
How would you assess disorganized thinking in the CAM
Misinterpret environment
Hallucinations/persecutory ideas
Mumbling/rambling
How would you do the 4AT assessment method for delirium?
Alert (0 or 4)
AMT4 (age, DOB, year, location) (0, 1, 2)
Attention (months backward) (0, 1, 2)
Acute change? (0 or 4)
4+ possible delirium
1-3 possible cognitive impairment
0 unlikely
What parts of the history would you focus more on in a delirious patient
Alcohol
Meds
- Analgesic
- Anti Ach
- Sedatives
- CS
- D ag
- Antidepressants
Take a collateral history if possible
What parts of the examination would you focus more on in a delirious patient
Presence, causes of delirium
AMT, MMSE cognitive test
Infection/dehydration/sensory impairment/pain
What investigations may you request and why?
Target potential causes
- FBC, U&E, glucose, LFT, TFT, Ca
- ECG, SaO2, CXR, ABG
- Drug levels, B12. cortisol
- Neuroimaging, EEG, lumbar puncture
What are the main characteristics of delirium
- onset
- alert
- attention
- sleep
- thinking
- perception
Onset
-sudden
Alert
-fluctuates
Attention
-fluctuates
Sleep
-pattern changes
Thinking
-disorganised
Perception
-hallucinations and delusions
What are the main characteristics of dementia
- onset
- alert
- attention
- sleep
- thinking
- perception
Onset
-gradual
Alert
-normal
Attention
-normal
Sleep
-can be disturbed
Thinking
- Short term memory is poor
- Can’t find right words
Perception
-normal
what are the main characteristics of depression
- onset
- alert
- attention
- sleep
- thinking
- perception
Onset
-gradual
Alert
-normal
Attention
-fluctuates
Sleep
-early morning waking
Thinking
-slow, -ve, hopeless
Perception
-normal
How would you manage delirium environmentally
Avoid moving patient around excessively
Natural light, calm, quiet, no uneccasery beeps
Clock, calendar
Decrease falls risk, tidy area
How would you manage delirium as an MDT
Address acute causes Reorientate patients Safety Promote normal sleep patterns Monitor progress, involve patient and family
