Delirium

2020 ◽  
pp. 6475-6477
Author(s):  
Bart Sheehan
Keyword(s):  
At Risk ◽  
Differential Diagnosis ◽  
Cognitive Impairment ◽  
Medical Condition ◽  
Visual Hallucinations ◽  
Common Cause ◽  
Medical Inpatients ◽  
Patient At Risk ◽  
Drug And Alcohol ◽  
Psychiatric Problems

Delirium is one of the most common psychiatric problems encountered in elderly medical inpatients. It involves a fluctuating cognitive impairment with reduced alertness and often with poorly formed delusions and/or visual hallucinations. The main differential diagnosis is from dementia, although delirium is more likely to develop in patients with existing dementia. Almost any medical condition that affects brain function may cause delirium. Infection is the most common cause, and it is important to consider prescribed drugs as a cause and to remember drug and alcohol withdrawal. Imperatives in management are first to keep the patient safe from harm (they may wander or put themselves in danger), and second to find and correct the cause. Urgent medical investigation and treatment is required as long periods of delirium put the patient at risk of harm, including permanent cognitive impairment.

Visual Hallucinations in Elderly People: Early Dementia, Psychosis or Charles Bonnet Syndrome? Review and Case Report

2017 ◽  
Vol 41 (S1) ◽  
pp. S650-S650
Author(s):  
M. García Moreno ◽  
A. De Cos Milas ◽  
B. Poza Cano ◽  
L. Beatobe Carreño
Keyword(s):  
Differential Diagnosis ◽  
Cognitive Impairment ◽  
Case Report ◽  
Psychiatric Illness ◽  
Late Onset ◽  
Medical Condition ◽  
Rare Condition ◽  
Disruptive Behaviour ◽  
Visual Hallucinations ◽  
Charles Bonnet Syndrome

IntroductionCharles Bonnet Syndrome (CBS) is an uncommon disease that involves visual hallucinations in visually impaired individuals, in absence of cognitive impairment or psychiatric illness, although some authors propose CBS as an early maker of dementia.ObjectivesShow the importance of differential diagnosis in individuals with presence of visual hallucinations, with distinction of CBS from others psychiatric or organic disorders such as hypnogogic and hypnopompic hallucinations, epileptic phenomenon, Parkinson disease, dementia, delirum tremens or late-onset psychosis.MethodsLiterature review about visual hallucinations in people with psychiatric illness, dementia or in absence of these status, followed by a case report of a patient who met criteria for CBS.ResultsEighty one-years-old female with no previous psychiatric illness, experience suddenly visual hallucinations (animals, insects) with secondary anxiety, fear and insomnia as well as disruptive behaviour (throw lye to kill the animals) and delusional interpretations of the hallucinations considering them as a divine proof. Clinical exam, neuroimaging tests and SPECT confirmed just a minimal cognitive impairment nor suggestive of dementia. She had personal history of cataracts and macular degeneration, with no other medical condition. Olanzapine was prescribed but it was withdrew because of adverse effects. Later, haloperidol was introduced with well tolerance and symptom's recovery ad integrum.ConclusionsCharles Bonnet syndrome is a rare condition that may sometimes be the beginning of a dementia. Medical evaluation and complementary tests help differential diagnosis in order to reject others psychiatric/somatic disorders. Neuroleptic and anti-epileptic treatment should be useful to control symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Visual Hallucinations as the Presenting Symptom of Senile Dementia

1992 ◽  
Vol 161 (2) ◽  
pp. 263-265 ◽  
Author(s):  
Peter M. Haddad ◽  
Susan M. Benbow
Keyword(s):  
Differential Diagnosis ◽  
Cognitive Impairment ◽  
Senile Dementia ◽  
The Elderly ◽  
Visual Hallucinations

A case of senile dementia that initially presented with complex visual hallucinations in the absence of clinical cognitive impairment or other psychopathology is described. Dementia must be added to the differential diagnosis of isolated visual hallucinations in the elderly.

Voltage-gated potassium channel limbic encephalitis presenting as functional cognitive impairment

2020 ◽  
Vol 13 (12) ◽  
pp. e233179
Author(s):  
Eric Garrels ◽  
Fawziya Huq ◽  
Gavin McKay
Keyword(s):  
Cognitive Impairment ◽  
Case Report ◽  
Potassium Channel ◽  
Limbic Encephalitis ◽  
Psychiatric Symptoms ◽  
Differential Diagnoses ◽  
Visual Hallucinations ◽  
Voltage Gated ◽  
History Of ◽  
Impaired Cognition

Limbic encephalitis is often reported to present as seizures and impaired cognition with little focus on psychiatric presentations. In this case report, we present a 49-year-old man who initially presented to the Psychiatric Liaison Service with a several month history of confusion with the additional emergence of visual hallucinations and delusions. Due to the inconsistent nature of the symptoms in the context of a major financial stressor, a provisional functional cognitive impairment diagnosis was made. Investigations later revealed a positive titre of voltage-gated potassium channel (VGKC) antibodies, subtype leucine-rich glioma inactivated 1 accounting for his symptoms which dramatically resolved with steroids and immunoglobulins. This case highlighted the need for maintaining broad differential diagnoses in a patient presenting with unusual psychiatric symptoms.

scholarly journals Early Moves: a protocol for a population-based prospective cohort study to establish general movements as an early biomarker of cognitive impairment in infants

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e041695
Author(s):  
Catherine Elliott ◽  
Caroline Alexander ◽  
Alison Salt ◽  
Alicia J Spittle ◽  
Roslyn N Boyd ◽  
...  
Keyword(s):  
At Risk ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Research Ethics ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Ethics Committee ◽  
Research Ethics Committee ◽  
National Implementation ◽  
General Movements

IntroductionThe current diagnostic pathways for cognitive impairment rarely identify babies at risk before 2 years of age. Very early detection and timely targeted intervention has potential to improve outcomes for these children and support them to reach their full life potential. Early Moves aims to identify early biomarkers, including general movements (GMs), for babies at risk of cognitive impairment, allowing early intervention within critical developmental windows to enable these children to have the best possible start to life.Method and analysisEarly Moves is a double-masked prospective cohort study that will recruit 3000 term and preterm babies from a secondary care setting. Early Moves will determine the diagnostic value of abnormal GMs (at writhing and fidgety age) for mild, moderate and severe cognitive delay at 2 years measured by the Bayley-4. Parents will use the Baby Moves smartphone application to video their babies’ GMs. Trained GMs assessors will be masked to any risk factors and assessors of the primary outcome will be masked to the GMs result. Automated scoring of GMs will be developed through applying machine-based learning to the data and the predictive value for an abnormal GM will be investigated. Screening algorithms for identification of children at risk of cognitive impairment, using the GM assessment (GMA), and routinely collected social and environmental profile data will be developed to allow more accurate prediction of cognitive outcome at 2 years. A cost evaluation for GMA implementation in preparation for national implementation will be undertaken including exploring the relationship between cognitive status and healthcare utilisation, medical costs, health-related quality of life and caregiver burden.Ethics and disseminationEthics approval has been granted by the Medical Research Ethics Committee of Joondalup Health Services and the Health Service Human Research Ethics Committee (1902) of Curtin University (HRE2019-0739).Trial registration numberACTRN12619001422112.

scholarly journals Implementation and effectiveness of a multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pei Ern Mary Ng ◽  
Sean Olivia Nicholas ◽  
Shiou Liang Wee ◽  
Teng Yan Yau ◽  
Alvin Chan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
At Risk ◽  
Cognitive Impairment ◽  
Mobile Application ◽  
Intervention Group ◽  
Blood Parameters ◽  
Attrition Rate ◽  
Control Group

AbstractTo address the paucity of research investigating the implementation of multi-domain dementia prevention interventions, we implemented and evaluated a 24-week, bi-weekly multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres (SCs). It comprised dual-task exercises, cognitive training, and mobile application-based nutritional guidance. An RCT design informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework was adopted. Outcome measures include cognition, quality of life, blood parameters, and physical performance. Implementation was evaluated through questionnaires administered to participants, implementers, SC managers, attendance lists, and observations. The program reached almost 50% of eligible participants, had an attrition rate of 22%, and was adopted by 8.7% of the SCs approached. It was implemented as intended; only the nutritional component was re-designed due to participants’ unfamiliarity with the mobile application. While there were no between-group differences in cognition, quality of life, and blood parameters, quality of life reduced in the control group and physical function improved in the intervention group after 24 weeks. The program was well-received by participants and SCs. Our findings show that a multi-domain program for at-risk older adults has benefits and can be implemented through neighborhood SCs. Areas of improvement are discussed.Trial registration: ClinicalTrials.gov NCT04440969 retrospectively registered on 22 June 2020.

Thiamine (Vitamin B1)

2011 ◽  
Vol 16 (1) ◽  
pp. 12-20 ◽  
Author(s):  
Aviva Fattal-Valevski
Keyword(s):  
Cognitive Impairment ◽  
Cerebral Metabolism ◽  
Oxidant Stress ◽  
Vitamin B1 ◽  
Vitamin B ◽  
Deficient Diet ◽  
Common Cause ◽  
Korsakoff Syndrome ◽  
Reducing Substances ◽  
B Vitamin

Thiamine (vitamin B1) was the first B vitamin to have been identified. It serves as a cofactor for several enzymes involved in energy metabolism. The thiamine-dependent enzymes are important for the biosynthesis of neurotransmitters and for the production of reducing substances used in oxidant stress defenses, as well as for the synthesis of pentoses used as nucleic acid precursors. Thiamine plays a central role in cerebral metabolism. Its deficiency results in dry beriberi, a peripheral neuropathy, wet beriberi, a cardiomyopathy with edema and lactic acidosis, and Wernicke—Korsakoff syndrome, whose manifestations consist of nystagmus, ophthalmoplegia, and ataxia evolving into confusion, retrograde amnesia, cognitive impairment, and confabulation. Patients on a strict thiamine-deficient diet display a state of severe depletion within 18 days. The most common cause of thiamine deficiency in affluent countries is either alcoholism or malnutrition in nonalcoholic patients. Treatment by thiamine supplementation is beneficial for diagnostic and therapeutic purposes.

Workshop 1: Differential Diagnosis

1997 ◽  
Vol 9 (S1) ◽  
pp. 85-86
Author(s):  
Martin Rossor
Keyword(s):  
Differential Diagnosis ◽  
Cognitive Impairment ◽  
Memory Impairment ◽  
The Other ◽  
Neuropsychological Measures ◽  
Clinical Criteria ◽  
Dementia Syndrome ◽  
Number Of Patients ◽  
Diagnostic Modalities ◽  
Made In

We were asked to consider differential diagnosis. We decided that it really is different from the other diagnostic modalities and cannot be treated in the same way as, for example, global or neuropsychological measures. In the context of this meeting, we believed it would be appropriate to consider clinical criteria. Thus, clinical criteria for the dementia syndrome as well as for specific diseases were discussed. We recognized that in the future, an increasing number of patients will present with cognitive impairment who do not fulfill the clinical criteria for dementia. These patients may alternatively have an isolated memory impairment syndrome. Nevertheless, a diagnosis will still need to be made in these patients, at least in terms of the underlying molecular pathology, in order to implement potential treatments.

Primary Biliary Cirrhosis

2015 ◽  
Author(s):  
Daniel S. Pratt ◽  
Lindsay Y. King
Keyword(s):  
Differential Diagnosis ◽  
Liver Disease ◽  
Primary Biliary Cirrhosis ◽  
Liver Diseases ◽  
American Association ◽  
Cholestatic Liver Disease ◽  
Biliary Cirrhosis ◽  
Common Cause ◽  
History Of

Primary biliary cirrhosis (PBC) is a progressive autoimmune disease of the liver. It is the most common cause of chronic intrahepatic cholestatic liver disease in adults. This review addresses the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of PBC. Figures show the pathogenesis and natural history of PBC and histologic features of the four stages of PBC. Tables list diagnostic criteria for PBC via the American Association for the Study of Liver Diseases, differential diagnosis for PBC, medications used to treat PBC, secondary therapy for PBC, and follow-up of patients with PBC. This review contains 2 highly rendered figures, 5 tables, and 45 references.

Identifying the Patient-at-Risk: Technology and ICU Outreach Services

2003 ◽  
pp. 971-981
Author(s):  
D. C. Scales ◽  
J. Granton ◽  
W. J. Sibbald
Keyword(s):  
At Risk ◽  
Outreach Services ◽  
Patient At Risk
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