Delirium and Dementia Flashcards
Discuss diagnostic criteria for delirium
1: disturbance in attention and awareness
2: The disturbance develops over a short period of time, represent change from baseline and tends to fluctuate in severity throughout the day
3: There are additional disturbances in cognition, such as memory, disorientation language, visual spatial ability or perception (hallucinatios and delusions)
4: The disturbances are not better explained by another pre-existing established or evolving neurocognitive disorder and do not occur in context of coma.
Discuss types of delirium
1: Hyperactive - hyperactivity with emotional lability, agitation and may include refusal of care
2: hypoactive: Sluggishness and lethargy
3: Mixed: normal level of activity but with disturbance of attention and awareness of fluctuations in activity levels
Breifly discuss rates of delirium in ED presentation
24% of older adults treated in ED have some level of delirium.
Mortality rate rises from 10% in those diagnosed in the ED to 36% when it is missed.
Discuss predisposing factors to delirium
Comorbid illness Age male gender medications neurologic deficitis psychiatirc illness
Discuss precipitating variables
Infections endocrine dysfunction metabolic disorders medications CNS event CVS disorder Iatrogenic related events
Discuss clinical features of delirium
- Disturbance in atterntion is central to the diagnosis of delirium
- Disorientation often accompanies the inattention but is not an invariable feature
- Always has some degree of memory impairment with the greatest impact on short term memory.
- Though processes and speech may become disorganised.
- Perceptual disturbance including misperception of the environment poorly formed delusions and hallucinations are common
-Disturbance in sleep wake cycle occurs early
List screening tools for delirium
CAM - confusions assessment method
MMSE
Richardmond agitation-sedation scale.
Compare and contrast prognosis of hypoactive and hyperactive delirium
Hypoactive delirium tends to be more common in elders and carries a wore overall prognosis
Describe dementia
Not a single entity but rather a highly variable clinical syndrome characterised by a gradually progressive deterioration of cognitive function.
It is classified as either irreversible (primary degenerative) or potentially reversible ( secondary)
Discuss primary degenerative dementias
Include Alzheimer’s disease, dementia with ley bodies,, subcortical dementias involving the basal ganglia and thalamus (e.g progressive supranuclear palsy and huntingtins chorea, Parkinson’s) and dementia of the fontral lobe type including Pick’s disease
With advancing ageing dementia mya have mixed causes with alzheimers and vascular dementia frequently co-existing
Discuss secondary dementias
Potential reversible and are caused by
- adverse drug reactions
- endocrinopathies
- metabolic abnormaltiies
- intracranial process
- depression
Discuss DSM v criteria for dementia
A: cognitive decline from a previous level of performance in one or more cognitive domains: complex attention, executive function, learning and memory, language, perceptual motor function or social cognition
B: The disorder has an insidious onset and gradual progression
C: The deficits do not occur exclusisvely druing the course of the delirium ‘
D: the cognitive deficits are not better explained by another mental disorder such as major depression or schizophrenia.
Discuss the MMSE as a screening tool for dementia
Validated more more than any other test and most frequently is recommended as a rapid screening tool. For hospitalized patient it has a sens of 87% and a spec of 82% for detection of organic brain syndrome
1) Registration section
- test both immediate and short term memory
2) Recall section also assess short term memory
- the ability to recall 2 of 3 objects has a 81% sens and 74% spec to exclude OBS
3) Serial sevens
- assess attetnion, concentration and arithmetic
Dysnomia (inability to name objects correctly) and dysgraphia (impaired writing ability) are two of the most sensitive indicators of delirium superimposed on dementia.
Discuss CAM
Cognitive assessment method Is a tool for screening delirium has four key features 1) Acute onset and fluctuating course 2) inattention 3) disorgnised thinking 4) ALOC
Compare and contrast delirium vs dementia
Delrium
- onset: acute
- awareness: reduced
- alertness: fluctuating
- orientation; impaired
- memory: impaired
- perception: hallucinations
- thinking: disorganised
- language; slow
Dementia
- Onset: Slow
- Awareness: clear
- Alertness: normal
- Orienation: impaired
- memory : impaired
- perecetpion: intact
- thinking: vague
- language: word finding difficulty
