Delirium

1. Characteristics

1. Acute onset sudden change in personality in hours to days

2. Altered conscious level Appear confuse
3. Changes in cognition Orientation, language, perceptual
disturbance:
hallucination, stupor, agitated
4. Fluctuating in course
5. Potentially reversible
6. Can be life threatening if misdiagnosed
7. Common in ICU ward
8. Often anxious, incoherent and unable to sleep normally

2. Predisposing factors

1. Advanced age
2. Preexisting dementia
3. Sensory impairment
4. Polypharmacy
5. Med illness
6. Malnutrition

3. Precipitating factors

(I WATCH DEATH)
Infection : UTI, pneumonia
Withdrawal : alcohol withdrawal , substances abuse
Acute metabolism : hyponatremia
Trauma : head trauma, hip fracture(air embolism), too much pain
CNS : meningitis, encephalitis
Hypoxia
Deficiency : malnutrition
Endocrinopathy
Acute vascular
Toxin or drug : Antiparkinson or steroid
Heavy metal

4. Treatment

1. Investigate & treat underlying cause!

2. Reduce disorientation
3. Correct under/overstimulation
4. Drug Rx for those severely disturbed Haloperidol, Quetiapine, risperidone. Minimum dose!
Short-acting Benzodiazepine lorazepam - short durations of rx,
minimum dose, but best avoided
5. Involve family members

5. Preservation of speech means

No matter what questions had been asked, the patient still

Dementia
6. Description

1. Impair in memory and cognitive function

2. No loss of consciousness
3. Progressively and non-reversible
4. Language skills, behavior and personality will be affected
5. Can be associated hallucinations and delusions
6. Affective symptoms : depression and anxiety

Cognitive Disorder