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 dont have any c onflic ts of inter est to disc lose whatsoever , inc luding (but
Clinical Identification of…
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
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
evalent in ger iatr ic populations.
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 impression of dementia.
De lirium o fte n subtle & vague sign of ser
ious under lying pr
Ho w do we de fine Delirium?
Co mplic ate d, but c o nso lidating e le me nts fro m UpT
He alth Partne rship, and DSM-V, de lirium is…
…an ac ute de c line fr
atte ntion/ c ognition assoc iate d with psyc homotor agitation that is c linic ally- pr
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
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/ I ADL s) and is no t fully e xplaine d by
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
Ho urs-days
Onset T iming
Gradual
Mo nths-ye ars
I mpaire d
Attention / Or ientation
Pre se rve d in e arly stag e s F luc tuating
L vl of Awar eness
No rmal I nc o he re nt Diso rg anize d
L anguage Speec h
Dise ase & Stag e De pe nde nt Variable F luc tuating
Memor y Impair ment
Sho rt-T e rm, e arly L
e rm, late r
Signs & Symptoms
I n additio n to de lirium c rite ria disc usse d be fo re
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”.
Care 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!
Obtain a good histor y o f what’ s be e n g o ing o n.
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.
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 .
Brie f Co nfusio n Asse ssme nt Me tho d
Ric hmo nd Agitatio n-S e datio n S c ale
Diffe r e ntial Diagnosis Mne monic s…
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
Anti-depr essants, e .g . mirtazapine
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
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!
T hank yo u!
Questions?
UpT
UpT
Unite d He alth Ne two rk: “De lirium Pre ve ntio n and Manag e me nt”