Structural Magnetic Resonance Imaging and Cognitive Ageing结构磁共振成像和认知老化.pptVIP

* * Alasdair MacLullich Professor of Geriatric Medicine Consultant in Geriatric Medicine University of Edinburgh What is delirium? Severe, acute neuropsychiatric syndrome Cognitive impairments Reduced or increased level of consciousness Psychotic features are common Resolves in 80% Mainly affects older people in hospital Delirium is common and serious 120 patients per 1000-bedded hospital 1 in 5 dead in a month ? New institutionalisation Strong marker of dementia Accelerates existing dementia; linked with new onset dementia Distressing High healthcare and social costs Yet … Only 20-25% detected Generally poorly managed Draft pathway Detection Detection of delirium “THINK DELIRIUM” NICE GUIDELINES, 2010 Core features Acute onset/fluctuating course Inattention Additional features Altered alertness (eg. drowsiness) Other cognitive deficits, eg. in memory Poor comprehension Psychotic features Sleep-wake cycle disturbance Delirium: many formal and informal terms Creates problems: imprecision Delirium and dementia get mixed up ‘Delirium’ triggers specific actions ‘Cognitive impairment’, ‘confusion’ usually don’t best to use the term ‘delirium’ Draft pathway states: local tools Most sites don’t have delirium screening implemented The 4AT being used in some sites: www.the4AT.com What method should be used for detection? Assessment Looking for causes 1: acute, severe illness If delirium suspected, treat as a medical emergency (1 in 5 are dead in one month) Nursing / medical input early ABC Pulse / BP / RR / saturations / temp / BM / check drugs Looking for causes 2: general assessment Standard history and examination, + FBC, UE, Ca, LFTs, glucose CRP TFTS ECG/CXR ABGs Urinalysis/MSU CT head / MRI (if head injury or focal neurological signs or if persisting delirium after 5 days) Looking