Acute Confusion (OSCE)

History Taking for the Onset of Acute Confusion

Major and Minor Criteria

 * diagnosis of delirium requires both major plus any one minor criteria
 * Can remember the criteria using the mnemonic AIDS:

Major

 * Acute onset and fluctuating course
 * Disorder of attention (inattention)

Minor

 * Disorganized thinking
 * Alterations in sensorium (e.g. visual or auditory hallucinations)

CC

 * need several iterations of the history, from several caregivers (may have large inter-observer differences in opinion)

HPI

 * onset
 * acute (<2-3 months)
 * chronic (> 3 months represents a dementing state)
 * progress
 * gradual decline, static, rate of fluctuation
 * palliating
 * precipitating
 * quality
 * AIDS
 * altered LOC
 * disorientation
 * memory
 * psychomotor agitation/retardation
 * altered sleep-wake cycle
 * severity
 * ADL → getting out of bed, using the bathroom, dressing, ambulation
 * IADL → cooking, laundry, shopping, banking, paying bills, driving
 * safety concerns
 * cognitive function (MMSE)
 * symptoms
 * behaviour changes - agitation
 * SAH → thunderclap headache
 * stroke → aphasia, paralysis
 * UTI → dysuria
 * pneumonia → cyanosis, cough, sputum, fever

Medications

 * benzodiazepines
 * beta-blockers
 * anticholinergics

PMHx

 * trauma
 * stroke
 * CAD
 * endocrinopathy
 * kidney
 * psych

FMHx

 * dementia
 * depression

SHx

 * EtOH
 * social support (caregiver stress), living arrangements

ROS

 * sleep pattern
 * visual changes
 * hearing loss
 * constipation
 * incontinence