Delirium Delirium KIE L ADAM MORRIS, DO BROADL AWNS GE RIAT - PowerPoint PPT Presentation

Clinical Identification of… Delirium Delirium KIE L ADAM MORRIS, DO BROADL AWNS GE RIAT RICS

Custo mary F inanc ial Disc lo sure S lide  I don’t have any c onflic ts of inter est to disc lose whatsoever , inc luding (but not limited to) financ ial r elationships.

My lofty goals for the ne xt 15 minute s…  c o nve y impor tanc e o f the to pic  define de lirium & de me ntia  re vie w c linic al pr esentation  re vie w evaluation o f de lirium  re vie w etiologies to c o nside r  addre ss tr eatment o f de lirium  re vie w pr evention strate g ie s  e nd with a c ase if time allo ws

Signific anc e – why disc uss de lirium?  It’s c ommon , so we ’ re all pro bably g o ing to se e this at so me po int.  Clinic se tting .  Ho spital se tting .  L o ng -T e rm Care se tting .  Our pe rso nal live s.  I t c an happen to anyone , no t just g e riatric patie nts.  But it’ s partic ularly pr ic populations . evalent in ger iatr  Ne arly 30% at so me po int during a ho spitalizatio n ( F ranc is, J., De lirium in Olde r Patie nts, JGS )  Co nse que ntly may le ad to a false positive impr ession of dementia .  De lirium o fte n subtle & vague sign of ser ious under lying pr oblem .

Ho w do we de fine Delirium? Delirium?  Co mplic ate d, but c o nso lidating e le me nts fro m UpT o Date , Unite d He alth Partne rship, and DSM-V, de lirium is…  …an ac ute de c line fr om base line atte ntion/ c ognition assoc iate d with psyc homotor agitation that is c linic ally- pr ovoke d and (ofte n) r e ve r sible .  I t c an c e rtainly be c o nside re d a syndro me witho ut a c le arly de fine d unifying patho physio lo g y.  Pe rhaps use ful to think o f de lirium as a state o f ac ute c o g nitive imbalanc e , whic h is c le arly muc h mo re e asily induc e d in e lde rly patie nts partic ularly tho se with de me ntia.

So the n, ho w do we de fine Dementia ?  Chr onic de c line in multiple do mains o f base line c o g nitio n ( me mo ry, le arning, atte ntio n, language , e xe c utive func tio n ) to a de g re e that inte rfe re s with individual func tio n ( ADL s ) and is no t fully e xplaine d by s/ I ADL alte rnative o r c o nc urre nt diag no se s ( e .g. ADHD, De pre ssio n, e tc ).

Distinguishing De lir ium & De me ntia Delirium Delirium Dementia Abrupt Gradual Onset Ho urs-days Mo nths-ye ars T iming I mpaire d Pre se rve d in e arly stag e s Attention / Or ientation F luc tuating No rmal L vl of Awar eness I nc o he re nt Dise ase & Stag e L anguage Diso rg anize d Speec h De pe nde nt Variable Sho rt-T e rm, e arly Memor y Impair ment F luc tuating L o ng -T e rm, late r

Signs & Symptoms n additio n to de lirium c rite ria disc usse d be fo re   I  F amily may say pt is “no t he rse lf” o r “o ut o f it”.  Alte rnative ly, may be ag itate d/ re stle ss.  F luc tuating c o urse ; may appe ar luc id o r “no rmal” . ounds !  Car e ful not to le t this fool you on mor ning r

De lir ium may be the only sign of se r ious illne ss in the e lde r ly!

CC: “Ma ain’t quite he r se lf for 3 days.”  Take this chief complaint seriously! Take this chief complaint seriously!  y o f what’ s be e n g o ing o n. Obtain a good histor  Ask abo ut spe c ific e le me nts o f “ain’ t quite he rse lf.”  Ask abo ut physic al sympto ms the y’ ve no tic e d.  Ask abo ut sig nific ant e nviro nme ntal c hang e s.  ough physic al , inc luding ne uro e xa m. Per for m a thor  Asse ss using c linic al tools spe c ific to de lirium, e .g . bCAM (ne xt slide ).  Dire c te d testing , e .g . labs, imag ing , L P, e tc .

B rie f C o nfusio n A sse ssme nt M e tho d

c ale e datio n S Ric hmo nd Agitatio n-S

e ntial Diagnosis Mne monic s… Diffe r

Drugs may c ause o r pro lo ng de lirium.  Analgesic s – NSAI Ds, Opio ids  Antibiotic s – e .g . fluo ro quino lo ne s  Anti-c holiner gic s  Anti-c onvulsants  essants , e .g . mirtazapine Anti-depr  Anti-Hyper tensives  Anti-spasmodic s (MSK) – e .g . c yc lo be nza prine  Anti-spasmodic s (GI) – e .g . dic yc lo mine  Cor toc oster oids  Hypnotic s – Ba rbs & Be nzo s

Pr e ve ntion is not always possible , but we c an tr y!

Ho w do we tr e at de lirium? F ix the glitc h!

hank yo u!  T Questions?

Sources  UpT o Date : “Diag no sis o f de lirium and c o nfusio nal state s”  UpT o Date : “Pre ve ntio n, tre atme nt, and pro g no sis o f de lirium…”  Unite d He alth Ne two rk: “De lirium Pre ve ntio n and Manag e me nt”