Delirium (lecture)

Question 1

What is delirium?

Answer 1

A state of mental confusion that develops quickly and often fluctuates in intensity. It involves reduced ability to focus, sustain, or shift attention.

Question 2

How is delirium different from dementia?

Answer 2

Delirium develops over a short period (hours to days) and fluctuates throughout the day. Dementia is a chronic, gradual decline.

Question 3

What are the key characteristics of delirium?

Answer 3

Disturbance of consciousness, reduced attention, cognitive change, perceptual disturbance, and fluctuating symptoms.

Question 4

What neurotransmitter imbalance is commonly associated with delirium?

Answer 4

Acetylcholine deficiency and dopamine excess.

Question 5

What is the acetylcholine reduction hypothesis related to delirium?

Answer 5

Anticholinergic drugs blocking acetylcholine can cause delirium. Drugs increasing acetylcholine are sometimes used as treatment.

Question 6

What metabolic disturbances are commonly linked to delirium?

Answer 6

Electrolyte imbalances, dehydration, glucose abnormalities.

Question 6

What is the dopamine excess hypothesis related to delirium?

Answer 6

Elevated dopamine levels may contribute to symptoms of delirium.

Question 7

How does inflammation contribute to delirium?

Answer 7

Inflammatory cytokines and microglial overactivation can disrupt brain function, especially in older adults.

Question 8

Why does blood-brain barrier (BBB) permeability increase the risk of delirium?

Answer 8

Increased BBB permeability with age allows inflammation-related damage to affect the brain more easily.

Question 9

What is the neuroinflammatory hypothesis related to delirium?

Answer 9

Proposes that elevated inflammatory markers during episodes contribute to cognitive impairment and delirium.

Question 10

Which areas of the brain are primarily affected by metabolic disturbances in delirium?

Answer 10

The frontal cortex and hippocampus, leading to changes in attention, memory, and cognition.

Question 11

What are the main neurotransmitters involved in delirium pathogenesis?

Answer 11

Acetylcholine (deficiency) and Dopamine (excess)

Question 12

What role does age play in the development of delirium?

Answer 12

Age increases the risk due to higher BBB permeability, microglial overactivation, and vulnerability to inflammatory processes.

Question 13

What are the common risk factors for developing delirium?

Answer 13

Dementia, multiple comorbidities, physical frailty, older age, sensory impairment, sleep deprivation.

Question 14

List precipitating factors for delirium.

Answer 14

Drug initiation/withdrawal, medical illness, surgery, pain, brain disorders (e.g., stroke, seizure).

Question 15

What are the first line investigations for delirium?

Answer 15

Blood tests (WCC, CRP, U&Es, LFTs, glucose, TFT, B12, Folate), ECG, Pulse oximetry, Urine analysis.

Question 16

What are the second line investigations for delirium?

Answer 16

CT/MRI head scan, Lumbar puncture, Bladder scan, EEG (if status epilepticus suspected).

Question 17

What mnemonic can be used to recall causes of delirium?

Answer 17

PINCHME: Pain, Infection, Nutrition, Constipation, Hydration, Medication, Environment.

Question 18

What does the mnemonic DELIRIUM stand for?

Answer 18

Drugs, Epilepsy/Electrolyte imbalance, Liver failure/Low oxygen, Infection, Retention, Intracranial, Uremia, Metabolism.

Question 19

How does pain contribute to delirium?

Answer 19

Pain can cause agitation, distress, and alter cognitive function, especially in older adults.

Question 20

Why are anticholinergic medications particularly problematic in delirium?

Answer 20

They block acetylcholine, which is crucial for cognitive function. Reduced acetylcholine is linked to delirium.

Question 21

What role does dehydration play in delirium?

Answer 21

Dehydration causes electrolyte imbalance and reduced blood flow to the brain, impairing cognition.

Question 22

What infections are commonly associated with delirium?

Answer 22

UTIs, pneumonia, sepsis, meningitis, encephalitis.

Question 23

How can surgery precipitate delirium?

Answer 23

Anaesthesia, pain, metabolic derangements, and post-operative complications can all contribute.

Question 24

What brain disorders are linked to delirium?

Answer 24

Stroke, seizure, intracranial haemorrhage, and brain tumours.

Question 25

What is the preferred imaging method for investigating delirium?

Answer 25

Contrast MRI to rule out structural causes such as stroke or tumour.

Question 26

What electrolyte imbalances are commonly linked to delirium?

Answer 26

Hyponatremia, hypercalcemia, hypoglycaemia.

Question 27

Why is a lumbar puncture used in investigating delirium?

Answer 27

To check for infection (e.g., meningitis) or elevated intracranial pressure.

Question 28

How does age increase the risk of delirium?

Answer 28

Increased blood-brain barrier permeability, reduced neurotransmitter levels, and greater susceptibility to inflammation.

Question 29

What clinical signs may indicate that a patient is experiencing delirium?

Answer 29

Fluctuating alertness, confusion, hallucinations, agitation, or sudden changes in cognition.

Question 30

How can unfamiliar environments contribute to delirium?

Answer 30

Sensory overload or deprivation, disruption of routine, and unfamiliarity can trigger or worsen delirium.

Question 31

What is the significance of retention (urinary or fecal) in delirium?

Answer 31

Retention causes discomfort, pain, and electrolyte disturbances, which can precipitate delirium.

Question 32

How is low oxygen (e.g., MI, PE) related to delirium?

Answer 32

Reduced oxygen supply to the brain impairs cognitive function and can cause confusion or delirium.

Question 33

What are the key components of a risk assessment for delirium?

Answer 33

Screening patients for delirium risk, minimizing polypharmacy, optimizing pain management, early mobilization, environmental modification, hydration, nutrition, and cognitive stimulation.

Question 34

How can environmental modification help prevent delirium?

Answer 34

Adjusting lighting, reducing noise, providing familiar objects, using clocks and calendars to aid orientation.

Question 35

What role does cognitive stimulation play in delirium prevention?

Answer 35

Providing meaningful activities to engage patients and support orientation.

Question 36

What is the purpose of the Mental Capacity Act (2005)?

Answer 36

To protect and empower individuals who may lack the capacity to make their own decisions, ensuring decisions are made in their best interest.

Question 37

According to the Mental Capacity Act, when does a person lack capacity?

Answer 37

When they cannot understand, retain, weigh up, or communicate a decision.

Question 38

What is the principle of 'least restrictive option' in the Mental Capacity Act?

Answer 38

Ensuring that care or treatment is provided in the least restrictive manner possible.

Question 39

What are Deprivation of Liberties Safeguards (DOLS)?

Answer 39

Legal measures used when a patient cannot consent to treatment and requires continuous supervision, with restricted freedom to leave.

Question 40

When are DOLS most commonly applied?

Answer 40

In hospital and care home settings where patients lack capacity to consent and require continuous supervision.

Question 41

What is the key difference between delirium and dementia in terms of onset?

Answer 41

Delirium has an acute onset (hours to days) while dementia develops gradually (months to years).

Question 42

What is the purpose of minimizing polypharmacy in delirium prevention?

Answer 42

To reduce the risk of medication-induced delirium, especially from anticholinergics and sedatives.

Question 43

What environmental modifications are recommended for patients with delirium?

Answer 43

Soft lighting, single rooms, reducing noise, providing orientation cues like clocks and calendars.

Question 44

How does early mobilization help in delirium prevention?

Answer 44

It prevents deconditioning, maintains physical function, and reduces risk of delirium.

Question 45

How should pain be managed to prevent delirium?

Answer 45

Adequate pain relief using simple analgesics and avoiding sedative medications where possible.

Question 46

What is the importance of hydration and nutrition in preventing delirium?

Answer 46

Dehydration and malnutrition are risk factors for delirium, so maintaining adequate hydration and nutrition is essential.