Collateral history for Delirium / Dementia

Introduction

• Wash hands
• Introduce self
• Ask Patient’s and relative’s names
• Explain the need for a collateral history
• Establish their relation to the patient

Presenting complaint

• Confusion/memory loss

History of presenting complaint

• Onset: determine if it is acute, chronic, or acute-on-chronic (establish baseline function and cognition)
• Progression: slowly progressive (Alzheimer’s), step-like (vascular)
• Triggers for decline (e.g. infection)
• Associated symptoms
  • Depression
  • Behavioural changes: aggression/agitation, disinhibition, personality changes
  • Psychiatric symptoms: hallucinations/delusions
  • Sleeping pattern: awake at night (Alzheimer’s), early morning waking (depression), fluctuating consciousness (delirium)
  • Cognitive disturbances: aphasia, apraxia, agnosia (Alzheimer’s)

Past medical history

• Ask about: Parkinson’s disease, vascular disease/diabetes, head injuries, recent infections
• Psychiatric history

Drug history

• Medications for related conditions (e.g. cardiovascular disease, Parkinson’s disease)
• Alzheimer’s drugs: galantamine, donepezil, rivastigmine
• New medications
• Allergies

Family history

• Related conditions, e.g. dementia, vascular disease, depression

Social history

• Living situation, carer/home support
• Mobility/walking aids
• Effect on function/coping with activities of daily living: washing, dressing, cooking, cleaning
• Working/driving
• Smoking, alcohol and other cardiovascular risk factors
• RISK
  • To self: wandering, leaving gas on, abuse, neglect by self or others
  • To others: aggression, risky behaviour
• Carer’s needs: determine how they are coping coping, discuss support options

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

Ending

• ICE (Ideas, Concerns, Expectations): from patient and carer perspective
• Summarise situation and patient needs
• Thank patient and relative
• Arrange follow up

Why don’t you test your knowledge?

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What are the possible causes of delirium?

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How would you assess a patient’s capacity?

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