Neurology - Neurocognitive Disorders
1. What is delirium?: Also known as Acute Confusional State
- an acute, transient, fluctuating disturbance in attention, cognition, and consciousness level
2. Who is delirium MC in?: MC in older adults, especially after surgery and in nursing home and ICU patients
3. What is delirium usually triggered by in younger individuals?: - triggered by DRUG
use or life-threatening disorders
4. What does delirium increase a patient's risk for?: - increases the risk for dementia
5. How can patients with dementia also experience delirium?: Delirium Superimposed
on Dementia
6. Describe the pathophysiology of delirium?: 1. Reversible impairment of cerebral oxidative
metabolism
2. Multiple neurotransmitter abnormalities (MC is Acetylcholine), especially cholinergic deficiency and generation of
inflammatory markers
7. Which inflammatory markers does delirium generate?: - CRP
- IL-1beta
- TNF-alpha
8. What is the risk of a delirium episode?: - Elevated risk of cognitive decline, functional impairment,
and mortality up to TWO YEARS following a delirium episode
,9. Why is it significant to treat hospitalized patients with delirium?: - Because delirium
greatly worsens prognosis for hospitalized patients, which is why it is an EMERGENCY
10. How can delirium be prevented?: Hospital staff members should be trained to take measures to
maintain:
- Orientation (turn the patient towards the window, put a larger clock, sign with hospital)
- Mobility
- Cognition
Ensure:
- Sleep
- Good nutrition
- Hydration
- Suflcient pain relief
11. What are the primary MCCs of delirium?: - Drugs (anticholinergics, PADs, opioids)
- Dehydration (electrolyte disturbances)
, - Infection (UTI, Pneumonia)
- No identified case
12. What are predisposing factors to delirium?: - Brain disorders (dementia, stroke, Parkinson's)
- Advanced age
- Sensory impairments (vision/hearing)
- Alcohol intoxication
- Multiple coexisting disorders
13. What are precipitating factors of delirium?: - Use of 3 or more new medications
- Medication toxicity in liver or kidney failure
- Shock, hypoxia
- Anemia, immobility, undernutrition
- Bladder catheters, hospitalization, pain
- Sleep deprivation, emotional stress
14. Which patients are especially at higher risk for delirium?: - Older patients with viral
diseases (COVID)
- Increased risk post-anesthesia, especially prolonged exposure
- ICU patients
15. What are the primary features of delirium?: - INATTENTION (focus, maintaining, shifting)
- Disorientation (time, place, person)
- Cognitive disturbances (hallucinations, delusions, paranoia)
- Confusion
- Disorganized thinking
- SUNDOWNING (less severe during the day and worse at night); fluctuation
16. Is quiet or excited delirium MC?: MC is quiet delirium, which is often misdiagnosed as depression
1. What is delirium?: Also known as Acute Confusional State
- an acute, transient, fluctuating disturbance in attention, cognition, and consciousness level
2. Who is delirium MC in?: MC in older adults, especially after surgery and in nursing home and ICU patients
3. What is delirium usually triggered by in younger individuals?: - triggered by DRUG
use or life-threatening disorders
4. What does delirium increase a patient's risk for?: - increases the risk for dementia
5. How can patients with dementia also experience delirium?: Delirium Superimposed
on Dementia
6. Describe the pathophysiology of delirium?: 1. Reversible impairment of cerebral oxidative
metabolism
2. Multiple neurotransmitter abnormalities (MC is Acetylcholine), especially cholinergic deficiency and generation of
inflammatory markers
7. Which inflammatory markers does delirium generate?: - CRP
- IL-1beta
- TNF-alpha
8. What is the risk of a delirium episode?: - Elevated risk of cognitive decline, functional impairment,
and mortality up to TWO YEARS following a delirium episode
,9. Why is it significant to treat hospitalized patients with delirium?: - Because delirium
greatly worsens prognosis for hospitalized patients, which is why it is an EMERGENCY
10. How can delirium be prevented?: Hospital staff members should be trained to take measures to
maintain:
- Orientation (turn the patient towards the window, put a larger clock, sign with hospital)
- Mobility
- Cognition
Ensure:
- Sleep
- Good nutrition
- Hydration
- Suflcient pain relief
11. What are the primary MCCs of delirium?: - Drugs (anticholinergics, PADs, opioids)
- Dehydration (electrolyte disturbances)
, - Infection (UTI, Pneumonia)
- No identified case
12. What are predisposing factors to delirium?: - Brain disorders (dementia, stroke, Parkinson's)
- Advanced age
- Sensory impairments (vision/hearing)
- Alcohol intoxication
- Multiple coexisting disorders
13. What are precipitating factors of delirium?: - Use of 3 or more new medications
- Medication toxicity in liver or kidney failure
- Shock, hypoxia
- Anemia, immobility, undernutrition
- Bladder catheters, hospitalization, pain
- Sleep deprivation, emotional stress
14. Which patients are especially at higher risk for delirium?: - Older patients with viral
diseases (COVID)
- Increased risk post-anesthesia, especially prolonged exposure
- ICU patients
15. What are the primary features of delirium?: - INATTENTION (focus, maintaining, shifting)
- Disorientation (time, place, person)
- Cognitive disturbances (hallucinations, delusions, paranoia)
- Confusion
- Disorganized thinking
- SUNDOWNING (less severe during the day and worse at night); fluctuation
16. Is quiet or excited delirium MC?: MC is quiet delirium, which is often misdiagnosed as depression
