Delirium and Memory Problems

Question 1

What is the most common mental health problem in hospitalised patients above the age of 65?

Answer 1

Delirium

Question 2

What are the main features of delirium?

Answer 2

Impaired consciousness
Disturbed cognition
Psychomotor disturbance
Emotional disturbance
Disturbed sleep-wake cycle

Question 3

What might be seen clinically if a patient has impaired consciousness?

Answer 3

Clouding
Drowsiness
Stupor
Coma

Question 4

What might be seen clinically if a patient has disturbed cognition?

Answer 4

Disorientated for time and place
Impaired memory and attention
Impaired thinking
Perceptual disturbance (hallucinations, delusions)

Question 5

What are the 2 main psychomotor variants of delirium?

Answer 5

Hypoactive
Hyperactive
Can get mixed picture

Question 6

What might be seen clinically if a patient has hypoactive delirium?

Answer 6

Confusion
Sedation
Depression (misdiagnosis)

Question 7

What might be seen clinically if a patient has hyperactive delirium?

Answer 7

Agitation
Aggression
Hallucinations, delusions
Disorientation

Question 8

Describe the course of delirium

Answer 8

Fluctuating, transient course
Rapid onset
Can last days to months depending on cause

Question 9

What drugs can typically cause delirium?

Answer 9

Anticholinergic
Anticonvulsant
Parkinson drugs
Steroids
Opiates
Alcohol
Illicit drugs

Question 10

Withdrawal from what substances can typically cause delirium?

Answer 10

Alcohol
Benzodiazepines
Illicit drugs

Question 11

List some metabolic abnormalities that can typically cause delirium

Answer 11

Hypoxia
Hypoglycaemia
Hypo/hyperthyroidism
Hypopituitarism

Question 12

No identifiable cause excludes a diagnosis of delirium. True/False?

Answer 12

False

Question 13

List the main risk factors for delirium

Answer 13

Elderly
Existing dementia
Perioperative
Immobility
Social isolation, stress

Question 14

List the main formal cognitive tests that should be carried out for delirium

Answer 14

MOCA
MMSE
4AT

Question 15

Sedating drugs can worsen delirium. True/False?

Answer 15

True

Question 16

How is delirium due to alcohol withdrawal managed with medication?

Answer 16

Benzodiazepine

Question 17

What is the general pharmacological management of delirium?

Answer 17

Antipsychotic - haloperidol

Question 18

Who typically gets hyperactive delirium?

Answer 18

Elderly with recent injury e.g. hip fracture

Question 19

What time of day is delirium typically worse?

Answer 19

Night

Question 20

What is the shortest type of memory?

Answer 20

Sensory memory (less than 1s)

Question 21

List the 2 main domains of long-term memory and their function

Answer 21

Explicit memory (conscious)
Implicit memory (unconscious)

Question 22

Procedural memory is part of what - implicit or explicit memory? What kind of memory does it enable?

Answer 22

Implicit memory
Remembering skills and doing tasks

Question 23

Declarative memory is part of what - implicit or explicit memory? What kind of memory does it enable?

Answer 23

Explicit memory
Remembering facts and events

Question 24

What are the 2 main domains of declarative memory and their memory functions?

Answer 24

Episodic memory (events, experiences)
Semantic memory (facts, concepts)

Question 25

What is anterograde amnesia?

Answer 25

Difficulty acquiring new material and remembering events since onset of illness/injury

Question 26

What is retrograde amnesia?

Answer 26

Difficulty remembering information prior to onset of illness/injury

Question 27

List some typical reports of memory problems

Answer 27

Forgetting a message Losing track of conversation Forgetting to do things Inability to navigate to familiar places Misplacing things Struggling with names

Question 28

What are the main domains assessed in cognitive screening?

Answer 28

Memory Attention, concentration Executive function Visuo-spatial function Language