delirium
Physiological disturbance that cause impairment of attention and awareness, with acute onset, and a fluctuating course
MSE Delirium
Cognition: Disorientated to time and place
impaired attention and concentration
short-term memory impaired
Language- dysphasia or incoherence
Disorganised thinking
Perceptual distubances- VH/illucinations
Psychomotor- Hypoactivation (lethargy apathy)/Hyper (agitation)
Causes of Delirium
Drugs
Infections- meningitis
Metabolic- uraemia, hyper/hypoglycaemia, hyponatraemia and dehydration
T-trauma
O- hypoxia
P- Postictal
Rx- Delirium
Rx underlying cause
1st line- haloperidol
Benzos- alcohol withdrawal or other drugs (lorazepam)
Risperidone/ ziprasidone IM
NCD/Dementia
Evidence of significant cognitive decline from a previous level of performance in or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor and social domains).
Cortical vs Subcortical dementia
CA- impaired but not prominent : Prominent (slow to focus)
LM- amnesic: forgetful (retrieve)
L- aphasic: not
S- NA- slow, dysarthric
VSP- present: present
Agnosia- Present : not
M- NA unless frontal: slow, rigid, tremor
T- NA u F: slow, rigid thinking
Alzheimers/frontotemporal dementia: Vascular, Parkinson’s, Huntingtons, Lewis bodies
Delirium:Dementia
OCD CRAMP2S
Delirium is an acute, fluctuating disturbance of attention and consciousness, whereas dementia is a chronic, progressive decline in cognition with preserved consciousness until late
pathology alzheimers
Cerebral shrinkage, hippocampus shrinkage and ventricle enlargement
B amyloid plaques and neurofibrillary tangles.
Mild vs major NCD
modest cognitive decline from previous performance level: substantial
insufficient intereferance on independence- greater effort required: sufficient
Presentation of delirium
Acute onset of:
Psychomotor symptoms: hyper or hypo
Impairment in attention, cognition, memory, consciousness, orientation
lability
Sleep-wake cycle disturbance
Hallucinations
Mx Delirium
Psychosocial:
- nurse in quiet, well-lit area with orientation techniques (like clocks and calendars)
- explain mgx to pt
- avoid restraints
- insure adequate hydration and access to ablution facilities
avoid late night nursing
avoid change of wards
encourage mobility
- MOST NB: find the cause and treat it
Pharm:
- Only pharm management if pt risk to self or others
- Single agent and titrate up slowly
- Haloperidol 0.5-1mg PO or IM BD
- OR Lorazepam 2-4mg PO
Dementia presentation
Impairment in memory and one or more associated cognitive defects
1. Significant cognitive decline from a previous level of performance
2. Interfere with independence for everyday activities (not if mild NCD)
3.Not exclusively in delirium setting
4. Not better explained by another mental illness
Must be slow, insidious onset with progressive course. Memory impairment (short term
then long term. Normal attention and alertness and usually intact orientation.
