Cognitive Impairment Knowledge Check

An 81-year-old man is brought to the emergency department with a 2-week history of confusion and several months of progressive short-term memory loss. His family notes that he has been falling over the past few weeks and has had difficulty with his balance. He doesn’t seem to recognize his family members and is more sleepy than usual. On physical examination, you note an alert, inattentive but cooperative patient. His Mini Mental Status Exam Score is in the impaired range. Further neurologic examination reveals the presence of ataxia and left leg weakness. Sensation testing is unremarkable.

Which test is NOT part of routine work-up for delirium.

An 85-year-old woman is sent to your ED with several days of intermittent drowsiness and aggressive behaviour. She is legally blind, wears a hearing aid, has limited mobility with a walker, and smokes. She was prescribed Valacyclovir and Amitryptiline for neuropathic pain from shingles last week.

What patient vulnerability factors does she have that place her at higher risk of developing delirium? Select all that apply.

Which statements about geriatric depression are FALSE?

Select all that apply.

A 72-year-old man presents to the ED with a two-day history of altered mental status. His wife tells you, “sometimes he doesn’t seem so bad but other times he is really out of it”. On physical exam, he is afebrile with normal vital signs. He is somewhat anxious but oriented to person, place, and year. He seems easily distracted and has trouble focusing on the interview. You perform a comprehensive evaluation that consists of a head CT, lumbar puncture, ECG, chest x-ray, and a comprehensive set of labs including a metabolic and infectious workout – all of which are unremarkable.

What is the next step in the management of this patient?

Approximately what proportion of delirium is recognized by ED physicians?