Encephalopathy, Delirium, and Dementia

A. See also

Metabolic, Toxic, and Deficiency Disorders, p. 69.

B. Management of agitation

1. Acute: See Psychiatric emergencies, p. 97.
2. Chronic: Risperidone (less sedating) or quetiapine (less risk of movement disorder). Although both have black box warnings in the elderly, there are few humane alternatives. Orally disintegrating or depo formulations for pts who cheek pills.

C. Delirium

Agitated confusion, usually with the implication of acute metabolic cause. Usually slurred speech, often frank hallucinations, motor signs (tremor, myoclonus, asterixis), rarely seizures.

1. DDx: Hypoxia, hypercapnia, electrolytes, glucose, drug overdose or withdrawal, sepsis, meningitis, encephalitis, high ammonia, uremia, Wernicke’s syndrome. Consider also depression, psychosis, thyroid storm, transient global amnesia, nonconvulsive status epilepticus, posterior leukoencephalopathy.
2. Tests: Consider head CT, ABG, EKG, electrolytes, BUN, Cr, Ca, ammonia, toxin screen, CBC, ESR, U/A and other infectious workup, LP, EEG.

D. Encephalopathy

Nonspecific term for diffuse brain dysfunction, often from systemic process, that is not a classic dementia.