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Essentials of Diagnosis
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Rapid onset and fluctuating course
Primary deficit is in attention rather than memory
May be hypo- or hyperactive
Dementia frequently coexists
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General Considerations
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Delirium is often the pathophysiologic consequence of an underlying general medical condition such as
Although the acutely agitated older patient often comes to mind when imagining delirium, such hyperactive delirium occurs less frequently than hypoactive delirium in hospitalized older adults
A key requirement is review of medications
Maintenance of a large number of drugs, addition of a new agent, and discontinuation of an agent known to cause withdrawal symptoms are often associated with development of delirium
Medications that are particularly likely to increase the risk of delirium include
Cognitive impairment is an important risk factor for delirium
Other risk factors
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Acute, fluctuating disturbance in attention and awareness of the environment occurring over a short time period
Inattention, inability to focus on tasks
Cognitive deficits, disorientation, memory and language impairment
Irritability
Hyper- or hypoactivity
Mental slowing
Hallucinations or illusions
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Differential Diagnosis
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Laboratory evaluation is aimed at finding an underlying medical condition
Routine studies include
Complete blood count
Blood urea nitrogen
Serum electrolytes, creatinine, glucose, calcium, albumin, liver biochemical tests
Urinalysis
ECG
In selected cases, serum magnesium, drug levels, arterial blood gas measurements, blood cultures, chest radiographs, urinary toxin screens, head CT scan, and lumbar puncture may be helpful
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Diagnostic Procedures
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