Collateral history for delirium / dementia

Question 1

Order of hx

Answer 1

PC - confusion or memory loss?
HPC - onset, progression, triggers, assoc. sx
PMH 
DH 
FH 
SH

Question 2

HPC

Answer 2

Onset - acute/chronic/acute-on-chronic

Progression - slowly progressive (AD) vs stepwise (VD)

Triggers - infection, stress

Assoc. sx

• Depression
• Psych - hallucinations / delusions
• Behavioural change - agitation, aggression, wandering, disinhibition, calling out
• Sleeping pattern - awake at night (AD), early am wakening (depression), fluctuating consciousness (delirium)
• Cognitive disturbances - aphasia, apraxia, agnosia, difficulty planning or organising

Question 3

Relevant PMH

Answer 3

Parkinson's
Vascular disease / diabetes
Head injuries 
Recent infections 
Psych hx

Question 4

Relevant DH

Answer 4

Blood pressure / diabetes meds
Parkinson's drugs 
AD - galantamine, donepezil, rivastigmine 
New meds 
Allergies

Question 5

Relevant FH

Answer 5

Dementia
Vascular disease
Depression

Question 6

Relevant SH

Answer 6

Living situation - carer/home support 
Mobility 
ADLs - washing, dressing, cooking, cleaning 
Working
Driving 
Smoking and alcohol 

RISK:

• self (wandering, leave gas on, abuse, neglect)
• others (aggression, risky behaviour)

Carer’s needs

• empathise with demands
• ask about stress, coping and support
• how they expect you to help
• what they worried about

Question 7

Causes of dementia

Answer 7

AD

• most common
• prevalence increases with age
• some genetic association
• slowly progression
• memory/cognitive impairment - 5A’s (amnesia, aphasia, apraxia, agnosia, anomia)
• due to generalised atrophy of cortex with amyloid plaques and neurofibrillary tangles

VD

• stepwise deterioration
• often multiple CVD RF
• may have focal neurology
• CT head - ischaemia or small vessel disease

LBD

• progressive dementia with daily fluctuations
• PD features
• Psych features - i.e. hallucinations

Other differentials

• frontotemporal lobe dementia
• CJD
• Depression - pseudo dementia
• HIV
• Huntington’s disease
• Normal pressure hydrocephalus
• SOL
• Nutritional deficiency - B12, thiamine, nicotinic acid
• Alcohol abuse
• Neurosyphilis
• Hypothyroidism
• Autoimmune / paraneoplastic