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