🎯 Pathology

• also known as ‘acute confusion state’

• it is a type of confusion that tends to affect the elderly (≥ 65 years) that can follow a multitude of risk factors

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💡 Risk factors

• age (≥ 65 years)

• cognitive impairment

• polypharmacy

• functional disabilities

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❗️ Potential triggers

• infections (especially urinary tract infections)

• change of environment

• alcohol withdrawal

• constipation

• metabolic disturbances: hyperglycaemia, hypoglycaemia, hypercalcaemia

• pain

• surgery

• sleep deprivation

• urinary retention

• dehydration

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🩺 Clinical features

• fluctuations in consciousness with lucid intervals

• reduced attention span

• impaired short-term memory

• hallucinations and delusions

• agitation

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🕵️‍♂️ Investigations

• full history and physical exam

  • note any changes in medications

• bedside tests

  • assessment of cognitive status

    • Mini Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA)

  • delirium screening tools

    • 4AT tool

  • ECG

• bloods

  • blood tests: FBC, U&Es, CRP, ESR, LFTs, TFTs, glucose, vitamin B12 and folate

  • blood cultures

• imaging

  • chest x-ray

  • CT brain (not routinely required)

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💆‍♂️ Management

• treat the underlying cause

• supportive

  • oxygen, fluids, optimise environment

• medical

  • haloperidol

  • lorazepam for patients with Parkinson’s disease

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🧲 High-yield tips

• delirium versus dementia

  • delirium is acute, causes fluctuations in consciousness, and affects perception causing hallucinations and delusions