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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: infection, stress
  • Associated symptoms
    • Depression
    • Psychiatric symptoms: hallucinations/delusions
    • Behavioural change: agitation, aggression, wandering, disinhibition, calling out
    • Sleeping pattern: awake at night (Alzheimer’s), early morning waking (depression), fluctuating consciousness (delirium)
    • Cognitive disturbances: aphasia, apraxia, agnosia, difficulty planning/organising

Past medical history

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

Drug history

  • Blood pressure/diabetes medication
  • Parkinson’s drugs
  • 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: empathise with the demands; ask about stress, coping, and support

Ending

  • ICE (Ideas, Concerns, Expectations): how does the relative/carer expect you to help? What are they worried about?
  • Summarise situation and patient needs. Thank relative.

Causes of dementia

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Why don’t you test your knowledge?

What are the defining clinical features of delirium?

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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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