Geriatrics Flashcards
(52 cards)
What is delirium?
An acute fluctuating syndrome of encephalopathy causing disturbed consciousness, attention, cognition and perception.
What are the 3 subtypes of delirium and how are they defined?
Hypoactive - reduced motor activity, lethargy, withdrawal, drowsiness and staring into space (most common in the elderly)
Hyperactive - increased agitation, delusions and disorientation
Mixed - switching back and forth between hypo and hyperactive states
What are the major risk factors for delirium? (x6)
- age 65+
- male
- pre-existing cognitive deficit e.g. dementia, stroke
- multiple comorbidities
- previous episodes of delirium
- recent surgery
What are some potential causes of delirium? (x5)
- acute infections (e.g. UTI, pneumonia, sepsis)
- prescribed drugs (e.g. benzodiazepines, analgesics, anti-parkinsons meds)
- toxic substances (e.g. alcohol, CO, substance misuse/withdrawal)
- metabolic causes (e.g. hypoxia, electrolyte imbalance, hypoglycaemia)
- surgery - due to problems with cranial bv’s, reduced bp during/after surgery, stress, increased inflammation in body/brain
What are the 8 signs of delirium?
Disordered thinking
Euphoric, fearful or angry
Language impairment
Illusions/delusions/hallucinations
Reversed sleep/wake cycle
Inattention
Unaware/disorientated
Memory impairment
What are the common differentials for delirium diagnosis? (x5)
- dementia
- depression
- bipolar disorder
- functional psychoses e.g. schizophrenia
- thyroid disease
What are the 4 categories of management which must be considered when treating delirium?
- supportive management
- environmemntal measures
- medical management
- management post-discharge
What are some supportive management measures for delirium? (x3)
- clear communication
- reminders of the day, time, location and identification of people
- readily visible clocks and calendars
- familiar objects in surroundings
- staff consistency
What are some environmental measures taken in delirium management? x4
- avoid sensory extremes
- encouragement of normal sleep/wake cycle
- control and maintenance of environment e.g. noise, lighting, temperature
- adequate nutrition
- maintain competence (e.g. walking in ambulant patients)
What are the aims in medical management of delirium? x3
- optimised treatment of comorbidities
- correct underlying precipitants (e.g. treat UTI, constipation etc.)
- only use pharmacological management in select patients who will benefit (e.g. antipsychotics)
What are the diagnostic tools used in assessing patients for delirium?
- CAM (confused assessment method)
- 4AT (4 A’s test = alertness, AMT4, attention, acute change or fluctuating course)
- DSM-5 (diagnostic and statistical manual of mental disorders)
What are the 6 main precipitants of delirium?
Pain
Infection
Nutrition
Co-morbidities
Hydration
Medication
Environment
+ bladder
What is dementia?
not a specific disease but a syndrome defined by memory impairment, some aspects of cognitive decline and difficulties with activities of daily living - it is caused by a number of brain disorders.
What are the 3 groups of symptoms seen in dementia patients?
- cognitive impairment (difficulties with memory, language, attention, orientation etc.)
- psychiatric or behavioural disturbances (changes in personality, emotional control, social behaviour)
- difficulties with ADLs (e.g. driving, shopping, eating, dressing)
What are the 4 main causes of dementia?
- Alzheimer’s disease (≈50%)
- Vascular dementia (≈25%)
- Lewy body dementia (≈15%)
- Fronto-temporal dementia (<5%)
What are some of the causes of potentially treatable dementias? (x5+)
- substance misuse
- hypothyroidism
- space-occupying intracranial lesions
- normal pressure hydrocephalus
- syphilis
- vit B12 deficiency
- folate deficiency
- pellagra (vit B3 deficiency)
What are the diagnostic criteria for all types of dementia?
There are cognitive or behavioural symptoms which:
- affect ability to function in normal activities
- represent a decline from a previous level of function
- cannot be explained by delirium or other major psychiatric disorder
- have been established by history-taking from patient and informant, and formal cognitive assessment
- involve impairment of at least two of the following domains:
- ability to acquire and remember new information
- judgement, ability to reason or handle complex tasks
- visuospatial ability
- language functions
- personality and behaviour
What are some examples of non-pharmacological treatments for dementia? x5
- cognitive stimulation programmes
- music/art/dance therapy
- aromatherapy
- structured exercise programmes
- multisensory stimulation
What are the 2 main groups of medications used in dementia treatment?
- ACE inhibitors e.g. donepezil, galantamine (most used in AD)
- N-methyl-D-aspartate (NMDA) antagonists e.g. ketamine, memantine, dextromethorphan
What are the questions in the 6 CIT test for dementia?
What year is it?
What month is it?
Give an address with 5 parts (John, Smith, 42, High, St, Bedford)
Count 20-1
Say months of year in reverse
Repeat address
What is depression?
the presence of depressed mood or diminished interest in activities occurring most of the day, nearly every day, for at least 2 weeks accompanied by additional characteristic symptoms
What are the characteristic symptoms seen in patients with depression? x8
- reduced ability to concentrate and sustain attention, or marked indecisiveness
- beliefs of low self-worth or excessive and inappropriate guilt
- hopelessness about the future
- recurrent thoughts of death or suicidal ideation
- significantly disrupted sleep or excessive sleep
- significant changes in appetite or weight
- psychomotor agitation or retardation
- reduced energy or fatigue
What are the 4 categories of depression severity?
- subthreshold symptoms - <5 symptoms
- mild depression - few symptoms in excess of the 5 required for diagnosis, symptoms resulting in minor functional impairment
- moderate depression - symptoms or functional impairment between mild and severe
- severe depression - most symptoms present + symptoms which interfere significantly with normal function
What is the definition of chronic depressive symptoms ?
people with chronic depressive symptoms include those who
1. continually meet the criteria for the diagnosis of a major depressive episode for at least 2 yrs
2. have persistent subthreshold symptoms for at least 2 yrs
3. have persistent low mood with or without concurrent episodes of major depression for at least 2 yrs
