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)
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.
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) ____________
4. Spell “WORLD” forwards. If able to complete,
spell “WORLD” backwards.
(One point for each correct letter, when
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)