Delirium

Question 1

What is a normal score on the animal naming test?

Answer 1

15

Question 2

What is Mini-Cog test used for?

Answer 2

Screens for delirium in primary care setting

Question 3

Confusion Assessment Method (CAM)

Answer 3

Used to diagnose delirium. Need all 3:
•Acute change in mental status
•Impaired attention
•Disorganized thinking or altered level of consciousness

Question 4

Main features of delirium

Answer 4

Waxing / waning of sxs, impaired attention, perseveration (saying same thing over and over), excessive somnolence, agitation. Pxs often look ill.
Disorientation, disturbance in sleep-wake cycles, visual hallucinations, paranoia, memory loss, mood instability, anxiety, irritability

Question 5

Causes of delirium (4 main categories)

Answer 5

• A – toxic: sedatives, hypnotics, anticholinergic meds, opiates, steroids, quinolone antibiotics, alcohol withdrawal (delirium tremens), sedative / hypnotic withdrawal
• B – metabolic: hypo / hypernatremia, hypo / hyercalcemia, hypoxemia (COPD), hypercapnia, renal failure (uremia), hepatic failure (hepatic encephalopathy)
• C – infections – UTI’s (elderly), pneumonia, meningitis, encephalitis, sepsis, CNS abscess. Delirium may last 1-2 weeks even after infection clears up.
• D – other: TBI, stroke, post-ictal state in epilepsy, cardiac ischemia, arrhythmia, pain, constipation, dehydration, nutrition, sensory deprivation (due to hearing impairment), changes in environment

Question 6

What is the final common pathway for causes of delirium?

Answer 6

Disturbance in RAS, which facilitates sensory input to the cortex via cholinergic projections to brainstem and thalamus, which project to cortex.

Question 7

DSM Criteria for Delirium (5 things)

Answer 7

• A – disturbance in attention and awareness
• B – disturbance develops over hrs / days and tends to fluctuate throughout the day
• C – Additional disturbance to cognition (memory deficit, disorientation, language, visuospatial ability, or perception)
• D – Not due to other neurocognitive disorder
• E – Sxs ARE caused by other medical condition, substance, or toxin

Question 8

Risk factors for delirium

Answer 8

Age, cerebrovascular disease, neurodegenerative disease (AD or PD), chronic medical conditions, recent surgery, being in unfamiliar environment, sedatives / hypnotics, anticholinergic meds, and malnutrition

Question 9

Prognosis for delirium

Answer 9

High mortality rate: 15% of elderly pxs w/ delirium die w/in 1 month. 25% w/in 6 months.

Question 10

Treatment for delirium (3 main things)

Answer 10

• # 1 is treating underlying medical condition.
• May need to be hospitalized if unable to care for self.
• Antipsychotics may be used for agitation.
• Benzos are avoided except for delirium tremens (treatment of choice).