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Delirium (Clinical
presentation
(vague, varied) (Confusion
(name, day,…
Delirium
Clinical
presentation
(vague, varied)
Confusion
(name, day, location)
Mood change
(fearful, agitated, depressed, angry)
Fluctuating conciousness
(reduced attention, focus)
Disordered thinking
(slow, incoherent, irrational, rambling)
Impaired language
(reduced, repetitive, rambling)
Psychosis
(illusions, delusions, hallucinations;
often tactile or visual rather than auditory)
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Motor features
(carphology/tilmus/floccillation
i.e. plucking at clothes, restless, still)
Behaviour change
(withdrawal, uncooperative, attitude)
Aetiology/
precipitants
Metabolic
Hepatic/renal failure (uremia)
Electrolyte imbalance
Hypoxia (resp/cardiac failure)
Hypoglycaemia
Anaemia
Malnutrition (B12, thiamine, folate, nicotinic acid)
Dehydration
Constipation
Urinary retention
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Infection
Pneumonia, UTI, wound infection
Meningitis, encephalitis
CNS abscess
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Vascular
Stroke, SAH, TIA
MI, shock, malignant HTN
Drugs
Sedatives e.g. benzodiazepines, opiates
Recreational e.g. drugs, alcohol withdrawal
Others e.g. L-DOPA, TCAs, AEDs
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Autoimmune
SLE, vasculitis
Risk factors
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Sensory impairment
(vision, hearing)
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Diagnosis
Examination
4AT test
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AMT4
(age, dob, place, year)
No mistake (0)
1 mistake (1)
2+ mistakes (2)
Attention
(months of year backwards)
7+ correct (0)
7 correct/refuses (1)
Untestable (2)
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General exam
-
Neuro, resp,cardio,
abdo, PR, musculoskeletal
Investigations
Bedside
Obs - sats, RR, HR, BP, temp
ECG
Bloods
FBC, CRP, U+E, Ca, LFTs, TFTs
ABG, BM (glucose)
SEPSIS 6 (blood cultures)
Imaging
Depending on likely cause
e.g. CXR, abdo USS/CT/MRI, EEG
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History
Patient, collateral
What is normal state
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Types
Hyperactive
(less common,
more recognised)
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Hypoactive
(more common,
less recognised)
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Epidemiology
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Risks mortality, cognitive decline, dementia
Management
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Definitive
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Conservative
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Orientate with clock, well lit room
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Medical
Sedation
Indication: distress, risk to self/others
E.g. haloperidol (not if PD/LBD), lorazepam,
benzodiazepine (if alcohol withdrawal)
NB. benzos can worsen confusion
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Definition
Acute/subacute neurological disorder
with impaired fluctuating conciousness plus
global impaired cognition and behaviour change
(abnormalities of perception and mood)
Prevention
Comprehensive Geriatric Assessment (CGA)
Hydration, mobility, sensory aids
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