assessment & work up of delirium patients
The most important step in diagnosing delirium is to obtain a history from a person who is taking care of the patient (e.g.- family member, caregiver etc) and carrying out a brief cognitive assessment (1)
- accurate history is necessary to
- to establish patients baseline cognitive functions and to identify any recent (within past 2 weeks) changes in mental status
- identify fluctuations in cognition and other symptoms typical of delirium
- look for a cause
- recent changes in disorder, new diagnoses
- review all current drugs (including over-the-counter and herbal preparations); pay special attention to new drugs and drug interactions
- review alcohol and sedative use
- assess for pain and discomfort (eg, urinary retention, constipation, thirst)
- cognitive screening test should be carried out
- e.g. - portable mental status questionnaire, the mini-cog, or the Montreal cognitive assessment
- if time constraints, can use the following assessment of orientation and an attention tasks in place of the basic screening
- naming of days of the week (no errors should be allowed) or months of the year (one error should be allowed) backwards
- serial sevens (one error should be allowed for five subtractions)
- recitation of digit spans (normally three or more) backwards (1)
Physical and neurological examination
- check for vital signs - temperature, oxygen saturation, fingerstick glucose concentration
- search for signs of occult infection, dehydration, acute abdominal pain, deep vein thrombosis, other acute illness;
- assess for sensory impairments
- search for focal neurological changes and meningeal signs (1)
Further assessment should be carried out according to the clues obtained from history and physical examination and previous results e.g. -
- targeted laboratory examinations and neuroimaging
- EEG
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