REVERSIBLE CAUSES OF CONFUSION [D-E-M-E-N-T-I-A]

Drugs, Endocrine, Metabolic, Ears-eyes-emotions, Nutritional deficiencies, normal pressure hydrocephalus, Thing that Take up space, Infections, Anything that prevents oxygenated blood from reaching the intra cranial arteries.

MEDICATIONS TO AVOID IN THE ELDERLY

I.                Antihistamines: Diphenhydramine, hydroxyzine. Anticholinergic effects include confusion, urinary retention, constipation, orthostatic hypotension and falls.

II.             Narcotic analgesics: Mepiridine and propoxyphene: Anticholinergic effects, opoid effects.

III.           Benzodiazepines: Confusion, falls, sedation.  Use only short acting benzos or low dose antipsychotics (lorazepam 0.5 q8, respiradone 0.5 bid)

IV.           Tricyclic antidepressants: amitriptyline, imipramine, doxepin: Anticholinergic effects over sedation.  Use SSRIs for depression, desipramine or nortriptyline or neuropathic pain.

V.              Antiemetics: promethazine, prochlorperazine, trimethobenzamide. Anticholinergic effects.

VI.           Histamine 2 receptor blockers: Confusion, depression, headache due to poor renal elimination.  Cut dose by 50% in the elderly.

GERIATRIC DEPRESSION SCALE (GDS15)

1. Are you basically satisfied with your life?
2. Have you dropped many of your interests and activities?
3. Do you feel your life is empty?
4. Do you often get bored?
5. Are you in good spirits most of the time?
6. Are you afraid something bad is going to happen to you?
7. Do you feel happy most of the time?
8. Do you often feel helpless?
9. Do you prefer to stay home rather than going out and doing new things?
10. Do you feel you have more problems with memory than most?
11. Do you feel it’s wonderful to be alive now?
12. Do you feel pretty worthless now?
13. Do you feel full of energy?
14. Do you feel your situation is hopeless?
15. Do you think most people are better off than you are?

8 depressive responses are consider diagnostic of major depression

OR: Answering “yes” to the single question: “Do you feel your life is empty now?”  identifies 84% of those with depression.

MINI MENTAL EXAMINATION (maximum score = 30 points)

1.         Time (Maximum Score 5 Points)

            A.  Year          ________        D.  Day           ________

            B.  Month       ________        E.  Season       ________

            C.  Date          ________

2.         Place (Max score 5 points)

            A.  State         ________       D.  Hospital   ________

            B.  County      ________       E.  Floor/Clinic         ________

            C.  Town         ________

3. Name 3 objects (hat, car, tree). (Max score 3 points)

Repeat until the patient learns all 3.

Hat     _________

Car     _________

Tree    _________

            Number of Trials      _________

4. Serial 7’s.  Stop after 5 correct answers            (Max score = 5 points)
(100 – 7 = 93; -7 = 86; -7 = 79; -7 = 65)  ____________

            OR

4. Spell “WORLD” forwards.  If able to complete,
spell “WORLD” backwards.

            (One point for each correct letter, when spelled backwards)
 ____________

5. Ask for the 3 objects in Section B.          ________ (max score 3 points)

6.         Name the objects: (One point for each word) (max score on 6-9 = 9 points.)
Watch _________   Pencil _________

7.         Repeat the phrase “No Ifs, Ands, or Buts” _________

8.         Follow a 3-stage command: Take a piece of paper in your right hand, fold it in half and place it on the floor _________ (3 points)

9.         Read and do the following: Close your eyes _________

10.       Write a sentence (grammar and punctuation are not important) (no score given)
________________________________________________
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