Dementia
True of False:
Dementia is a normal part of aging
False
This cognitive deficit is the most consistent and defining feature of delirium.
Inattention
What is the difference between short-term insomnia versus long-term insomnia?
Short term is due to stressors (ex. financial difficulty, divorce, etc.)
Long-term is persistent and disabling, usually associated with substance use disorder, or medical/psychiatric disorders such as depression
True or False:
Suspect client has 'drug-seeking behaviour' if client knows exact drug for back pain/headache or presenting with repeated accidents
True
What is a screening tool for delirium versus dementia
Delirium: CAM
Dementia: MSE/mini MSE, clock draw test
This term describes cognitive decline that is present without loss of functional independence.
Mild cognitive impairment (MCI)?
This subtype of delirium is characterized by lethargy, decreased responsiveness, and is frequently under-recognized.
Hypoactive delirium
Name 2 differential diagnosis for Insomnia
1) Alcohol or substance use disorder
2) Major depressive disorder
3) Medical problems --> chronic pain, anxiety, BPH, diuretic use, menopause
4) Sleep disorder d/t work demand, social media scrolling, napping, emotional stressors (job loss, hospitalization)
What are some physical signs of substance use?
Needle track, "meth mouth", ruddy nose, spider angiomas
What is AUDIT / AUDIT-C used for?
BONUS POINTS (extra 200) if you can state how many points are needed to screen positive for AUDIT or AUDIT-C
Used for alcohol use disorder screening
Alcohol use disorders identification test (condensed)
AUDIT = 8 or more
AUDIT-C = 3 or more (women), 4 or more (men)
Early personality changes, disinhibition, and executive dysfunction are most characteristic of this dementia subtype
Frontotemporal Dementia
Why is delirium considered a medical emergency in older adults?
Because it signals an acute underlying medical illness and is associated with increased morbidity, mortality, and long-term cognitive decline.
What are some findings of transient insomnia?
Sleep problems (ex. jet lag)
Situational stress
Unfamiliar surrounding
Name 3 types of diagnostic tests for Insomnia
CBC, electrolytes, TSH, FSH, LH, PSA, creatinine, urea
Drug screen
Urinalysis (if indicated)
Sinus x-rays
Sleep studies (R/O OSA)
What important safety responsibility must clinicians address when a patient is diagnosed with dementia?
Assessing driving safety and fulfilling mandatory reporting requirements when cognition may impair driving.
This validated bedside tool is most commonly used by non–mental health professionals to screen for delirium in clinical settings.
Confusion Assessment Method (CAM)
What should be asked in the history of a patient presenting with insomnia
What is the CAGE questionnaire/test for and what does it stand for?
To collect subjective data or substance use
C - cut down
A - annoyed
G - guilty
E - eye opener
Why is dementia considered a diagnosis of exclusion?
Reversible causes of cognitive impairment, such as delirium, depression, metabolic abnormalities, and medication effects, must first be ruled out.
Why is delirium associated with increased long-term morbidity and mortality in older adults?
Delirium reflects acute cerebral decompensation and is linked to functional decline, institutionalization, and increased risk of future dementia.
What is the criteria to diagnose insomnia?
Complains of sleep quality, quantity, timing for ≥3x/week for ≥1 month.