This document provides information about confusion, dementia, delirium, and depression in acute hospital settings. It defines the conditions, describes their causes and symptoms, and provides assessment and diagnostic tools. Key points include that dementia, delirium, and depression can all cause confusion; their symptoms can overlap but they have distinct features; delirium is the most common cause of acute confusion in hospitals and often indicates an underlying medical problem; and early recognition and treatment is important for outcomes.
The world’s population is ageing rapidly, and with it is coming to a significant increase in the number of
older people with dementia. This increase presents major challenges for the provision of healthcare
generally and for dementia care in particular, for as more people have dementia, there will be more
people exhibiting behavioural and psychological symptoms of dementia (BPSD).
BPSD exact a high price from both the patient and the caregiver in terms of the distress and disability
they cause if left untreated. BPSD is recognisable, understandable and treatable. The recognition and
appropriate management of BPSD are important factors in improving our care of dementia patients
and their caregivers,
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
The world’s population is ageing rapidly, and with it is coming to a significant increase in the number of
older people with dementia. This increase presents major challenges for the provision of healthcare
generally and for dementia care in particular, for as more people have dementia, there will be more
people exhibiting behavioural and psychological symptoms of dementia (BPSD).
BPSD exact a high price from both the patient and the caregiver in terms of the distress and disability
they cause if left untreated. BPSD is recognisable, understandable and treatable. The recognition and
appropriate management of BPSD are important factors in improving our care of dementia patients
and their caregivers,
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
Presentation delivered by Dr. Carol Manning at the live webinar hosted by AlzPossible at www.alzpossible.org on the 17th of March, 2014.
www.alzpossible.org
somatoform disorders are characterized by persistent requests for medical attention because of physical complaints that cannot be sufficiently explained by medical causes.
Status epilepticus (SE) is a medical emergency that starts when a seizure hits the 5-minute mark (or if there’s more than one seizure within 5 minutes).
Convulsive Status epilepticus-
The convulsive type is more common and more dangerous.
It involves tonic- clonic seizures (grand mal seizures)
In the tonic phase ( lasts less than 1 minute), body becomes stiff and person lose consciousness. Eyes roll back into head, muscles contract, back arches, and trouble breathing.
As the clonic phase starts, body spasms and jerks occur. Neck and limbs flex and relax rapidly but slow down over a few minutes.
Once the clonic phase ends, patient might stay unconscious for a few more minutes. This is the postictal period.Non-convulsive Status epilepticus-
Patient lose consciousness but is in an “epileptic twilight” state.
There might not able any shaking or seizing at all, so it can be very hard for someone observing patient to figure out what’s happening.
A non-convulsive seizure can turn into a convulsive episode.
Poorly controlled epilepsy
Low blood sugar
Stroke
Kidney failure
Liver failure
Encephalitis
HIV
Alcohol or drug abuse
Genetic diseases such as Fragile X syndrome and Angelman syndrome
Head injuries
Depression is the leading cause of disability world wide and is a major contributor to the overall global burden of diseases .At its worst depression can cause suicide .
There are effective psychological and pharmacological treatments for depression
Main topics about acute confusional state, including the following:
Definition
Pathophysiology
Epidemiology
History
Description and presentation, with short video about the essential features of delirium and approach procedures
Causes, toxic,drug-induced, infectious, central nervous system insults, respiratory conditions, endocrine disorders, cardiac problems, environmental effects, pregnancy complications
Differential diagnosis: all organic and some non organic diseases of central nervous system, endocrine disorders, metabolic disturbances,
Assessment
Lab studies, CBC, blood glucose, PT, PTT, INR, liver function, thyroid function, electrolytes, ABG, toxins assays, urinalysis
Imaging studies: CT brain. MRI brain, plain abdominal film
Emergency management, supportive measures, rapid sequence intubation,
Presentation delivered by Dr. Carol Manning at the live webinar hosted by AlzPossible at www.alzpossible.org on the 17th of March, 2014.
www.alzpossible.org
somatoform disorders are characterized by persistent requests for medical attention because of physical complaints that cannot be sufficiently explained by medical causes.
Status epilepticus (SE) is a medical emergency that starts when a seizure hits the 5-minute mark (or if there’s more than one seizure within 5 minutes).
Convulsive Status epilepticus-
The convulsive type is more common and more dangerous.
It involves tonic- clonic seizures (grand mal seizures)
In the tonic phase ( lasts less than 1 minute), body becomes stiff and person lose consciousness. Eyes roll back into head, muscles contract, back arches, and trouble breathing.
As the clonic phase starts, body spasms and jerks occur. Neck and limbs flex and relax rapidly but slow down over a few minutes.
Once the clonic phase ends, patient might stay unconscious for a few more minutes. This is the postictal period.Non-convulsive Status epilepticus-
Patient lose consciousness but is in an “epileptic twilight” state.
There might not able any shaking or seizing at all, so it can be very hard for someone observing patient to figure out what’s happening.
A non-convulsive seizure can turn into a convulsive episode.
Poorly controlled epilepsy
Low blood sugar
Stroke
Kidney failure
Liver failure
Encephalitis
HIV
Alcohol or drug abuse
Genetic diseases such as Fragile X syndrome and Angelman syndrome
Head injuries
Depression is the leading cause of disability world wide and is a major contributor to the overall global burden of diseases .At its worst depression can cause suicide .
There are effective psychological and pharmacological treatments for depression
Main topics about acute confusional state, including the following:
Definition
Pathophysiology
Epidemiology
History
Description and presentation, with short video about the essential features of delirium and approach procedures
Causes, toxic,drug-induced, infectious, central nervous system insults, respiratory conditions, endocrine disorders, cardiac problems, environmental effects, pregnancy complications
Differential diagnosis: all organic and some non organic diseases of central nervous system, endocrine disorders, metabolic disturbances,
Assessment
Lab studies, CBC, blood glucose, PT, PTT, INR, liver function, thyroid function, electrolytes, ABG, toxins assays, urinalysis
Imaging studies: CT brain. MRI brain, plain abdominal film
Emergency management, supportive measures, rapid sequence intubation,
Emergency Department and Outpatient Senior Healthcare Consultant Coursenomadicnurse
The one day course provided by Piedmont Hospital of ED and outpatient nursing staff on Geriatric Patient care issues. Funded by the HRSA Comprehensive Geriatric Education Grant.
Presentation made March 17, 2017 and hosted by AlzPossible - www.alzpossible.org.
Review recording at http://alzpossible.org/webinars-2/the-basics-memory-loss-dementia-and-alzheimers-disease/
This presentation JoAnne Nowak and I gave for NHPCO last spring addresses the prevention, assessment and treatment of delirium - particularly in hospice and palliative care settings.
Alzheimer's disease: Clinical Assessment and ManagementRavi Soni
This PPT is a seminar on the Alzheimer's disease which was prepared for sensitizing post graduate psychiatry students on the day of World Alzheimer's Day.
what is dementia and why it is considered only for old age and how it goes to misdiagnose buy the health care professionals and what is infact. in nepal this issues is given low priority in both hospital and public
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
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Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
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By Dr. Vinod Kumar Kanvaria
2. a mental state characterized by disorientation
regarding time, place, person, or situation. It
causes bewilderment, perplexity, lack of
orderly thought, and inability to choose or act
decisively and perform the activities of daily
living
4. Dementia – some causes treatable
Delirium – usually treatable and often the
first symptom of serious underlying
condition
Depression – often responds well to
treatment
All benefit from adaptations to care
5. The development of multiple cognitive deficits manifested by:
A. Two or more of the following cognitive disturbances:
(a) aphasia (language disturbance)
(b) apraxia (impaired ability to carry out motor activities depite intact motor function)
(c) agnosia (failure to recognize or identify objects despite intact sensory function)
(d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
(e) memory impairment (impaired ability to learn new information or to recall previously
learned information)
B. The cognitive deficits in criteria A each cause significant impairment in social or occupational functioning and
represent a significant decline from a previous level of functioning.
C. The course is characterized by gradual onset and continuing cognitive decline
6. Alzheimer’s Disease - 30% to 50%
Vascular Dementia - 20% (but 50% of cases in
hospital)
Lewy Body Dementia – 10% to 30%
Frontal Lobe Dementia – 5%
Other causes - <5%
7. Attention
Concentration
Orientation
Short term memory
Long term memory
Praxis
Language
Executive function
8.
9. Delirium is a syndrome, or group of
symptoms, caused by a disturbance in the
normal functioning of the brain. The delirious
patient has a reduced awareness of and
responsiveness to the environment, which
may be manifested as disorientation,
incoherence, and memory disturbance.
Delirium is often marked by hallucinations,
delusions, and a dream-like state.
10. CONFUSION ASSESSMENT METHOD (CAM) SHORTENED VERSION WORKSHEET
I. ACUTE ONSET AND FLUCTUATING COURSE BOX 1
a) Is there evidence of an acute change in mental status from the patient’s baseline? No ____ Yes___
b) Did the (abnormal) behaviour fluctuate during the day, that is tend to come and go or increase and
decrease in severity? No ____ Yes___
II. INATTENTION
Did the patient have difficulty focusing attention, for example, being easily distractible or having difficulty
keeping track of what was being said? No ____ Yes___
________________________________________________________________________
III. DISORGANIZED THINKING BOX 2
Was the patient ‘s thinking disorganized or incoherent, such as rambling or irrelevant conversation, unclear
or illogical flow of ideas, or unpredictable switching from subject to subject? No ____ Yes____
IV. ALTERED LEVEL OF CONSCIOUSNESS
Overall, how would you rate the patient’s level of consciousness?
Alert (normal) or
___ Vigilant (hyperalert)
___ Lethargic (drowsy, easily aroused)
___ Stupor (difficult to arouse)
___ Coma (unarousable)
Do any checks appear? (any level of consciousness other than ‘normal’) No ____ Yes ___
________________________________________________________________________
If all ‘Yes’s’ in Box 1 are checked and at least one ‘Yes’ in Box 2 is checked a diagnosis of delirium is suggested.
12. Three types of delirium;
Hyperactive:
Agitated, calling out, restless, wandering
Least common, most frequently diagnosed
Increased risk of falls and injury
Hypoactive:
Lethargic, slow to answer questions
Most common, most dangerous, least recognised
Increased pressure ulcer risk and aspirational pneumonia
Mixed: combination of the above
13. Increased morbidity
Increased mortality
Increased falls
Higher length of stay
Decreased likelihood of return home
Eight fold increase of new diagnosis of
dementia
Longer the delirium remains untreated the
greater all of the above risks
14. CHARACTERISTI
CS
DEMENTIA DELIRIUM DEPRESSION
Onset Insidious, slow and often
unrecognized
Sudden, abrupt Recent, may correspond
with life change
Course over 24
hours
Fairly stable, may see
changes due to stresses
Fluctuating, often with
nighttime exacerbations
Fairly stable, may be
worse in the morning
Consciousness Clear Reduced Clear
Alertness Normal Increased, decreased or
variable
Normal
Psychomotor
activity
Normal but may have
apraxia
Increased, decreased,
mixed
Variable, agitation or
retardation
Duration Months to years Hours to weeks Variable (at least 6
weeks) may be months to
years
Attention Generally normal Globally disordered,
fluctuates
Little impairment, very
distractible
Orientation Often impaired (answer
may be close to right)
Usually impaired,
variable, fluctuates
Usually normal, may
answer “don’t know”
Speech Difficulty word finding,
preseveration
Often incoherent, slow
or rapid
May be slow
15. Right place, right time, right approach
History is essential (recent and longer term)
Confusion isn’t restricted to a single cause, at
least 5 out of 6 patients with delirium will
already have dementia
Communication difficulties will need serious
consideration
Be aware of impact of identifying a problem
Refer (RAID)
16. Alzheimer’s Society –
http://www.alzheimers.org.uk/site/scripts/documents.php?categoryID=200
293
Other cognitive assessments;
Addenbrooke’s Cognitive Assessment -
http://www.stvincents.ie/dynamic/File/Addenbrookes_A_SVUH_MedEl_tool.p
df
6 Item Cognitive Test –
http://www.patient.co.uk/doctor/six-item-cognitive-impairment-test-6cit
MMSE –
http://www.guysandstthomas.nhs.uk/resources/our-services/acute-
medicine-gi-surgery/elderly-care/mini-mental-state-evaluation.pdf
17. Confusion Assessment Method training manual -
http://www.viha.ca/NR/rdonlyres/0AC07A64-FF24-41E3-BDC5-
41CFE4E44F33/0/cam_training_pkg.pdf
European Delirium association –
http://www.europeandeliriumassociation.com/
18. Differential diagnosis – dementia and depression;
http://www.cmglinks.com/cmg/lectures_dementia/part1/006.htm
Depression in older adults (RCP);
http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/depression/depressioninol
deradults.aspx
Depression rating scales;
Geriatric Depression Scale –
http://www.chcr.brown.edu/GDS_SHORT_FORM.PDF
Cornell Scale For Depression In Dementia –
http://geropsychiatriceducation.vch.ca/docs/edu-downloads/depression/cornell_scale_depression.pdf