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DSM: 3 A + 1 change cognition, evidence of cause. 3As: Acute & fluctuating, impaired attention and awareness 1 of: Memory, Visospatial, Language, Perception

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Screening Tool

CAM - Confusion Assessment Tool (may miss hypoactive typ), 4AT (<4)

Definition & Epidemiology

Delirium is an acute disorder of attention and cognition that is common, life-altering, but preventable.

• 20–30% of older adults in emergency departments,
• up to 50% post-surgery,
• 80% in ICU settings.

It is usually a CNS manifestation of non-CNS problem.

I feel like anything can cause delirium. It is almost like an ‘ABC’ that tells Pt may be ‘unstable’ and you need to investigate further.

Diagnosis (Bedside Assessment)

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Note: under Hospitalization setting:

• When Notice Personality change, behavioural change:
  • Think of delirium every time
  • Hard to wake up → Most likely hypoactive delirium

Quick Screening Test

• Acute onset: collateral hx
• Attention → Bedside Attention Test
  • serial 7, month of the year backward
• Disorganized thinking → Bedside Disorganized Thinking Test
  • Are there fish in the sea? do rocks flow, is 1 pound more than 2 pound (ICU)
  • Lots of older adult have tangential thinking, =/= disorganized thinking
• Altered LOC: GCS (3-15) </aside>

Mimicker

• Dementia vs Depression vs Delirium

Etiology

DIMS Workup

• D → Drug & withdrawal

  • !Stimulant Intoxication , Z-drugs, !Alcohol Withdrawal (5 dy), !Benzo Withdrawal (2/8, 2-7 dy), SSRI/SNRI

• I → Infection

  • UTI (Urine Analysis)
  • Pneumonia (CXR - Chest X ray)
  • Pressure injury → SSTI
  • Osteomyolytis (probe to bone)

• M → Metabolic

  Cause	RF	Test
  ‣	AKI	‣ → Na, Ca, K,
  ‣ deficiency → ‣	Poor nutrition, from street, ‣, Liver Disease	B1 level, ‣
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