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Basics :
Cognition refers to tasks that include:
memory short/long term
language
orientation
judgment
problem-solving
planning
ability to have interpersonal relationships
praxis (perform actions)
The cognitive decline was not present from birth or very early in life
therefore represent a decline from a previously attained level of
functioning.
Agnosia: Failure to recognize familiar objects
Aphasia: Failure to produce of comprehend verbal speech
Apraxia: Failure to execute complex motor skills
Difficulty in EFx: Ability to think abstactly and diff with activities of
daily life.
Deliurium
Predisposition/Risk factors :
Age(old age)
Psychiatric comorbidities (esp.mood disorders)
Sensory impairment (blind or deaf)
Nutritional problems: Malnutrition, anorexia etc etc
Drug intoxication/Dependance(alcohol any other drugs).
Surgical floor-Anesthics
Etiology :
Drugs Anticholinergics (codeine,Xanax, Chlorpheniramine),
Benzos,Heroin.
Dehydration
Infections- meningitis
CNS Seizures, Trauma
Endocrine- Diabetes
organ failure( cardiac, renal, hepatic),
hyper or hypoglycemia
Metabolic- acidosis/alkalosis Resp Failure, diabetes,
Classification:
Subtypes :
Hypoactive subtype - apathy and quiet confusion are present and
easily missed. This type can be confused with depression.
Hyperactive subtype - agitation, delusions and disorientation are
prominent and it can be confused with schizophrenia.
Mixed subtype - patients vary from hypoactive to
hyperactive.
Assessment:
ABCs.
Conscious level.
Vital signs - eg, pulse oximetry, pulse, blood pressure, temperature.
Full cardiovascular and respiratory examination.
Full abdominal and genitourinary examination, if appropriate.
Full neurological examination.
Further examination depending on the suspected problem - eg, ENT
or rectal examination.
Treatment:
Supportive therapy
Clear communication.
Reminders of the day, time, location and identification of
surrounding persons.
Have a clock available.
Have familiar objects from home around patients, especially glasses,
walking aids and hearing aids.
Staff consistency - both doctors and nurses.
Relaxation - eg, watch television.
Involve the family.
Pharmacotherapy
Haloperidol or olanzapine are preferred, using the lowest possible
dose for the shortest possible time (normally a week or less).
In delirium resulting from alcohol withdrawal (delirium tremens), a
benzodiazepine such as diazepam or chlordiazepoxide is preferred.