Decoding the Signs of Altered Mental State in Older Adults

Older adults presenting to the Emergency Department (ED) with altered mental status (AMS), delirium, or confusion are at a higher risk of acutely abnormal computed tomography (CT) findings if they exhibit a focal neurological deficit ().

This is one conclusion of Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review published in the June issue of Academic Emergency Medicine (AEM) journal, the peer-reviewed journal of the Society for Academic Emergency Medicine (SAEM).

The Neurological Connection

Objectives of the systematic review and meta-analysis were to report the proportion of older ED patients presenting with delirium who have acute abnormal findings on head imaging and to assess whether anticoagulation, neurological deficits, trauma, or headache were associated with head imaging abnormalities in these patients.

Delirium - Types, Causes, Symptoms, Signs, Diagnosis, Treatment
Delirium is a sudden disturbance in mental function that causes confusion and decreased awareness of one’s environment. It is classified into three subtypes – hyperactive, hypoactive and mixed.

‘When older adults arrive at the Emergency Department (ED) with altered mental status (AMS), delirium, or confusion, the presence of a focal neurological deficit increases the likelihood of detecting acutely abnormal findings on computed tomography (CT). # Delirium, #Altered Mental Status, #Confusion ’

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The lead authors of this article are Shan W. Liu, MD, SD, associate professor of emergency medicine at Harvard Medical School, and Sangil Lee, clinical associate professor of emergency medicine at the University of Iowa Carver College of Medicine.

With this study, Liu et. al found that 16% of head CTs ordered in the ED on older adults presenting with delirium, AMS, or confusion had an acutely abnormal finding.

Anticoagulation was not associated with an abnormal head CT and findings of a focal neurologic deficit greatly increased the odds of an abnormal head CT. The authors were unable to comment on the association of headache or trauma with an abnormal head CT.

ICU Delirium - Causes, Symptoms, Diagnosis, Treatment
ICU delirium is the most dreaded and least diagnosed complication of an illness which requires treatment in the critical care unit.

This systematic review was conducted on behalf of the Geriatric Emergency Department Delirium Guidelines Group. It lays the groundwork for determining a recommendation for geriatric ED guidelines regarding brain imaging for all delirious older adults in the ED

Reference:

Head computed tomography findings in geriatric emergency department patients with delirium, altered mental status, and confusion: A systematic review - (https://onlinelibrary.wiley.com/doi/10.1111/acem.14622)

Decreased Consciousness - Symptom Evaluation
Consciousness can be decreased to various degrees and result in conditions like delirium, stupor, coma, persistent vegetative state, minimal conscious state and brain death.

Source-Eurekalert