Delirium: The Daily PANCE Blueprint
A 72-year-old male has been in the hospital for 7 days due to pneumonia. Clinically, he has been improving with antibiotic therapy. However, today you notice he has become confused, somnolent during the daytime, and restless. He denies pain or worsening of symptoms. Lab values are unremarkable. Which of the following is this the patient most at an increased risk of?
A. Dementia
B. Myocardial infarction
C. Anxiety disorder
D. Alcohol withdrawal
E. Hemorrhagic stroke
Answer and topic summary
The answer is A. Dementia
This patient has delirium, which is defined as an acute disturbance in consciousness characterized by fluctuating course of attention and a change in perception or cognition. There are different types of delirium (hypoactive, hyperactive, mixed). Delirium should not be ignored as people who experience delirium have an eight-fold increase in their risk of dementia. Medical causes of altered cognition/attention should be ruled out first with appropriate labs and studies (e.g., hypertensive encephalopathy, sepsis, hypoglycemia, uremia, electrolyte derangements, acidosis, seizure, tumor, etc.). Management of delirium includes avoiding meds that exacerbate the problem (like benzos and antihistamines) and optimizing the patient’s environment and circadian rhythm (limit noise, provide glasses/hearing aids, re-orient to place and time, OT/PT, exposure to natural light, strict days and nights).
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Neurology ⇒ ⇒
Also covered in Internal Medicine, and Family Medicine PAEA EOR topic lists
