Snapshot A 69-year-old male is brought to the ED by his daughter for an acute change in his mental status. According to the daughter, three days ago he was fine, but when she visited him today he was barely responsive and when he did speak he did not make any sense. On physical exam, you see a patient who is obtunded and not responsive to verbal stimuli though he is responsive to painful stimuli. The patient is mildly febrile and has dry mucous membranes. IV fluids are started, and blood levels of thiamine and B12 are sent as well as a CBC and CMP. Delirium Acute onset change of consciousness with waxing and waning symptoms ↓ attention span ↓ level of arousal Characterized by acute changes in mental status disorganized thinking hallucinations (often visual) illusions misperceptions disturbance in sleep-wake cycle cognitive dysfunction abnormal EEG Most common psychiatric illness on medical and surgical floors may be caused by drugs with anticholinergic effects often reversible Treatment treat the underlying cause Snapshot A 69-year-old male is brought in by his daughter due to his "bad memory." The daughter states that three years ago he began having trouble remembering incidental things such as names, phone numbers, and addresses, though he was fine paying his bills, shopping and cooking. As time went on he began to struggle paying his bills on time. More recently, his daughter has had to take over all his finances and has to cook for him as he is no longer able to do any of these things. In addition, he can't remember his daughters name and refers to her as "some broad." Major Neurocognitive Disorder (NCD) Gradual loss in cognition NO CHANGE in level of consciousness memory loss is present Characterized by memory deficits aphasia apraxia agnosia loss of abstract thought behavioral/personality changes impaired judgment no loss of alertness ↑ incidence with age normal EEG Caused by Alzheimer's disease slow decline in memory and ability to take care of oneself thrombosis/hemorrhage can have acute onset sudden decline in mental status HIV Pick's disease change in personality + loss of memory substance abuse CJD sudden, aggressive and often irreversible change in personality and loss of memory Classification - made clinically, not by specific criteria major NCD minor NCD Depression may present as dementia in elderly patients known as pseudodementia patients with pseudodementia are concerned with memory loss patients with real dementia tend to try and conceal their memory loss