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45 Cards in this Set
- Front
- Back
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What is characterised by an acute decline in both the level of consciousness and cognition, with particular impairment in attention? |
Delirium |
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Is Delirium reversible? |
Yes potentially. |
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What is the principal symptom of delirium? |
An impairment of consciousness, in association with global impairments and cognitive functions. |
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What are some of the psychiatric symptoms of delirium? |
Abnormalities of mood, perception, and behaviour. |
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What are some of the neurological symptoms of delirium? |
Tremor Asterixis Incoordination Urinary incontinence |
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How does delirium most commonly affect general health? |
Can lead to accidental injury because of the patient's clouded consciousness. |
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What proportion of terminally ill patients develop delirium? |
80% |
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What two categories can risk of delirium be conceptualised into? |
Predisposing factors and precipitating factors. |
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What proportion of nursing home residents older than age 75 have repeated episodes of delirium? |
Around 60% |
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How is delirium differentiated from dementia? |
Time to development of symptoms is usually short in delirium, with the exception of dementia related to a stroke. Delirium can fluctuate over the course of the day as dementia tends to be more consistent. Decreased consciousness is more common in delerium, where as dementia patients can be more alert. |
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How is delirium differentiated from schizophrenia or depression? |
Patients with schizophrenia usually experience no change in their level of consciousness or orientation, whereas delirium patients do. The hypoactive symptoms of delirium can be differentiated from depression with the use of an EEG.
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What is criterion A for delirium? |
The disturbance in attention and awareness such as reduced ability to focus, sustain, and shift attention.
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Was criterion B for delirium? |
The disturbance develops over a short period of time (hours to days), represents a change from baseline attention and awareness and fluctuates throughout the day. |
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What is criterion C for delirium? |
An additional disturbance in cognition (memory deficit, to citation, language, visuospatial ability, or perception) |
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Criterion D for delirium describes the rule outs, what are these? |
Cannot be better explained by pre-existing or evolving neurocognitive disorders and does not occur in the context of severely reduced level of arousal, such as coma. |
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Criterion E for delirium is? |
There is evidence from the history, physical examination, or laboratory findings that the disturbance has direct physiological antecedents including medical condition, substance intoxication or withdrawal or exposure to a toxin. |
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What is the pneumonic for causes of delirium?
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I WATCH DEATH
Infection Withdrawal Acute metabolic Trauma CNS pathology Hypoxia Deficiencies Endocrinopathies Acute vascular Toxins or drugs Heavy metals |
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What are the 5 specifiers for delirium? |
Substance intoxication delirium substance withdrawal delirium medication induced delirium delirium due to another medical condition delirium due to multiple aetiologies |
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What are the duration specifiers for delirium? |
Acute, lasting a few hours or days. persistent, lasting weeks and months. |
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What are the activity specifiers for delirium? |
Hyperactive, may be accompanied by mood lability, agitation, refusal to cooperate. Hypoactive, reduce level of psychomotor activity including sluggishness and lethargy. Mixed level of activity, including those whose level actively fluctuates. |
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What is the disease marked by progressive cognitive impairment of consciousness? |
Dementia |
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What are the critical clinical points of dementia? |
The identification of the syndrome and, the clinical workup of its cause. |
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As dementia sometimes reversible? |
Yes if the pathology is correctly identified and it fits into the reversible category then it can be, approximately 15% of people with dementia have reversible illnesses with treatment is initiated before irreversible damage takes place. |
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What are the 4 main types of dementia? |
Alzheimer's disease Lewy bodies related dementia vascular dementia frontotemporal dementia TBI prion disease Parkinson's disease Huntington's disease |
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What is one of the initial cues that suggest a diagnosis of dementia should be carefully considered? |
Complaints of a personality change in a patient over 40 years.
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What should clinicians note in relation to cognitive deficit, when exploring a diagnosis of dementia? |
Complaints about intellectual impairment or forgetfulness. Attempts to evade, deny or rationalise cognitive deficits as a form of avoidance/denial. |
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What are some of the characteristic behaviours associated with early dementia? |
Excessive orderliness. Social withdrawal. A tendency to relate events in minute detail. Sudden outbursts of anger or sarcasm. |
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What aspects of the patient's appearance and behaviour might indicate dementia? |
Lability of emotions. Sloppy grooming. Uninhabited remarks. Silly jokes. Dull, apathetic facial expression. Memory impairment. |
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What form of memory impairment is usually associated with the onset of dementia? |
Memory for recent events normally goes 1st. As the course progresses only the earliest information is recalled. |
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What 2 forms of dementia can affect the patient's language abilities? |
Alzheimer's and vascular dementia, as they affect the cortex. |
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What symptom of dementia can be especially disturbing for families? |
Personality changes. In particular pre-existing personality traits may be accentuated during the development of the dementia. |
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What proportion of dementia patients have hallucinations? |
About 30%, and 30 or 40% have delusions primarily of paranoia or persecutory nature. Patients with delusions are often aggressive towards caregivers. |
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40 to 50% of dementia patients experience what forms of other of other symptoms? |
Mood symptoms, including both depression and anxiety. |
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What are some of the additional neurological symptoms associated with vascular dementia? |
Headaches. Dizziness. Faintness. Weakness. Focal neurological signs. And sleep disturbances. |
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What are the differential diagnoses when considering dementia? |
Alzheimer's type versus vascular dementia. Vascular dementia is versus transient ischaemic attacks. Delirium. depression. Factitious disorder. Schizophrenia. Ageing. Other disorders. |
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How might you differentiate Alzheimer's type versus vascular type dementia? |
Focal neurological symptoms are more common in vascular dementia than in Alzheimer's. |
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How might you differentiate vascular dementia from transient ischaemic attacks (TIAs)? |
TIA is a brief episodes of focal neurological dysfunction lasting less than 24 hours, usually 5 to 15 minutes.
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How might you differentiate delirium from dementia? |
Generally dementia has a longer onset and duration of cognitive impairment and a more stable symptom pattern. |
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How might you differentiate depression from dementia? |
Some patients with depression can have symptoms of cognitive impairment that are difficult to distinguish from dementia, often termed depression-related cognitive dysfunction. They typically have depressive symptoms, more insight into their symptoms and and a history of depression. |
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How might you differentiate factitious disorder from dementia? |
Often patients with fictitious disorder will simulate memory loss in an erratic and inconsistent manner. Whereas genuine dementia patients tend to lose most recent memories 1st. |
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How would you differentiate normal cognitive decline from dementia? |
Normal cognitive decline is generally minor and does not significantly interfere with a person's social or occupational behaviour. |
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What are the 3 basic indicators of delirium? |
Disturbance and level of awareness or attention. Acute onset. Relatively brief duration. Fluctuating course |
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Describe what is known as sundowning? |
The intensity of delirium often fluctuates. Most patients will be lucid in the morning and worse at night. This is the transient phenomenon known as Sundowning. |
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What is one tactic for determining delirium? |
Interview the candidate twice with a period of time between 2 sessions, or alternately have nursing staff track and record the lucidity of the candidate. |
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What are the 6 areas in which a significant cognitive decline might indicate dementia? |
Complex attention. Executive function. Learning and memory. Language Perceptual-motor ability. Social cognition. |
