Confusion and Delirium

Question 1

Delirium Definition

Answer 1

Abnormalities of thought, perception and levels of awareness

• Acute onset and intermittent
• Do not assume it is caused by dementia

Question 2

Delirium Epidemiology

Answer 2

• 30% of those in emergency departments
• Most common complication of hospitalisation in elderly
• Prevalence higher in malignancy and HIV

Question 3

Delirium RFs

Answer 3

Age ≥65, male, dementia, previous Hx, hip fracture…

Question 4

Delirium Aetiology

Answer 4

Acute infections (many sources)

• Prescribed drugs (Benzos, morhpine, anticholinergics…)
• Surgery
• Many more

Question 5

Delirium Presentation

Answer 5

• Cognitive function test, collateral Hx for premorbid personality
• Acute/subacute, fluctuating course, impaired; consciousness, concentration, memory, sleep, abnormalities of perception, agitation, emotional lability, psychotic symptoms common, neurological signs

Question 6

Delirium Subtypes

Answer 6

• Hypoactive- apathy and quiet confusion, often confused with depression
• Hyperactive- agitation, delusions and disorientation can be confused with schizophrenia
• Mixed- patients vary between both

Question 7

Delirium Confusion Assessment Method (CAM)

Answer 7

For positive result patient must have

1. Acute onset and fluctuating course and
2. Inattention (20-1 test) and either
3. Disorganised thinking or
4. Changed level of consciousness

Question 8

Delirium Differentials

Answer 8

Dementia (Lewy body (fluctuating course)), depression, bipolar disorder. functional psychosis (schizophrenia)

Question 9

Delirium Ix

Answer 9

• Full Hx and exam
• Bloods
• Urine dipstick and microscopy
• ECG
• Obs
• Following may be necessary according to findings; ABG, CXR, CT, LP, EEG

Question 10

Delirium Management

Answer 10

• Treat underlying cause
• Regular measures of cognitive function
• Management can be divided into
• Supportive (clock, reminders of time/day, familiar objects, staff consistency, family involvement
• Environmental (avoid sensory over or under stimulation, adequate space, single rooms, control excess noise, room lighting, temperature, if wandering think of cause)
• Medical (Mostly can worsen, if aggressive antipsychotics may help (haloperidol))
• Post-discharge (symptoms last longer than underlying condition, prepare family for this)

Question 11

Delirium Complications

Answer 11

Hospital acquired infections, pressure sores, fractures, residual cognitive impairment, stupor, coma, death