Geriatrics - Confusion Flashcards
(28 cards)
what are the 6 neurocognitive domains in DSM5?
motor, language and executive function, complex attention, learning and memory, social cognition
why is important to assess cognition?
associated with risk of death, capactiy, may alter appropriateness of tests.
What should you ask in the hx to diagnose cognitive impairment?
onset- when and how rapid? Course- fluctuating or progressive decline, associated features- other illness or functional loss?
what is delerium?
disturbed conciousness, change in cognition, acute onset and fluctuating, sleep disturbance, emotional disturbance
what precipitates delirium
most common complicaiton of hospitalisation, infection, dehydration, pain, drugs, hypoxia, urinary retention, sleep disturbance, brain injury. Effects 20-30% of patients
what are the types of distured conciousness?
hypoactive, hyperactive, mixed
What is 4AT?
delerium assessment tool for 65 and over, alertness, amt4, attention, acute change or fluctuating course?
What is AMT4?
Abbreviated mental test, 4 questions asked quickly (age, dob, place of birth, current year)
what do you do when you find delerium?
treat the cause (full history and exam), explain the diagnosis, pharmacological / non-pharma measures
Name the non-pharmacological tx of delerium
use families and carers to reorientate and reassure patients, encourage mobility and self-care, correct sensory impairment, normalise sleep-wake cycle, ensure continuity of care, avoid urinary caths and venflons.
Name the pharmacological tx of delerium
stop anitcholinergics and sedatives. Drug tx usually not nessesary. Only if in danger to themselves or others use quetapine orally.
quick definition of dementia…
Acquired decline in memory and other cognitive functions in an alert person sufficiently severe to cause functional impairment and present for more than 6 months
types of dementia…
alzheimers, vascular, mixed, lewy body, fronto-temporal
alzheimers definition and rf’s
slow incidious onset, loss of recent memory, progressive funcitonal decline. Rf’s: age, vascularm genetics
vascular dementia and rf’s
step-wise deterioration, executive dysfunction, gait problems. Rf’s: t2dm, af, ihd, pvd.
lewy body dementia definition
fluctuant, hallucinations, associated with parkinsonism, falls common.
fronto temporal dementia definition
earlier age onset, behavioural change, language difficulties, lack of insight into diffiuculties.
how is dementia diagnosed and what are the problems with the tests.
MMS exam or Montreal cognitive assessment. Can be culturally/generation ally specific, falsely resassuring, remember to use in parallel with the Hx.
pharmacological mx of dementia?
cholinesterase inhibitors (Galantamine, Rivastigmine (used more in lewy body)), anti-psychotics (increases risk of cvs death, also start low and go slow)
nonpharmacological mx of dementia?
support, cognitive stimulation, exercise, environmental design, avoid changes in environment, care planning.
what are the reversible causes of dementia?
hypothyroidism, intracerebral bleeds/tumours, b12 deficiency, hypercalcaemia, normal pressure hydrocephalus (wet wobbly wacky), depression.
what to think about when considering capacity to consent to tx…
capacity decision specific, do they hhave a legally appointed proxy (welfare POA or guardian)
name the members of the MDT in caring for dementia…
physios, nurses, pharmacists geriatricians, psychiatrists, social workers, OT’s.
case 1 …
82m, aande, walking with trouser down on the street. Hx fro family- increasing forgetful over past year, gradual decline over past 2 years.
