1. Delirium
Nancy Weintraub, MD, FACP Professor of Medicine, UCLA Director, UCLA Geriatric Medicine Fellowship Director, VA Special Advanced Fellowship in Geriatrics at GLA VA

2. Definition Acute alteration of consciousness Inattention
Can look like dementia
Reversible
More common in patients with dementia
Lack of brain reserve during stress

3. CAMS 1. Acute change in mental status and fluctuating course
2. Inattention
3. Disorganized thinking
4. Altered level of consciousness
Requires features 1 and 2 and either 3 or 4

4. 1. Acute change in mental status and fluctuating course
Do we have that? How do we find out?
History
Observation
Collateral sources

5. Do we have that? How do we find out? Conversation
2. Inattention
Do we have that? How do we find out?
Conversation
Reverse months or days of the week
Calculation tasks

6. 3. Disorganized thinking
Conversation
Reasoning questions

7. Altered level of consciousness
Somnolence
Agitation

8. Consequences of Delirium
Persistent or early cognitive decline
Prolonged hospitalization
Increased risk of death
Increased risk of institutionalization

9. Some Causes
Medications added (especially anticholinergics or sedatives) or subtracted
Metabolic derangements
Infections
Sensory deprivation
Restraints
Anesthesia
Pain
Lack of Sleep

10. Preventive Strategies
Mobility
Light in daytime, quiet and dark at night
Avoid known anticholinergic drugs
Frequent orientation
Avoid restraints, catheters, tubes, etc.
Friends and family present

11. Dealing with Delirium
Attempt to remove all potentially causative agents/environmental factors, e.g.
Remove restraints
Remove as many tubes as possible
Remove potentially contributing medications
Treat pain
Resume necessary medications inadvertently left out
Treat infections
Light in day, quiet and dark at night
Enlist family and friends
Get patient out of bed

12. Dealing with Delirium Last resort: low dose antipsychotics
Only if safety is at risk
Never in hypoactive delirium

13. Delirium may not clear until patient returns to familiar environment