QUESTION #1:
Q: Is this patient delirious, demented, or both?
A: This is a classic presentation for delirium.
She may have a coexisting dementia, although this determination can't be made in the presence of a delirium. However, she is apparently able to live somewhat independently in an apartment, suggesting it is unlikely to be a severe dementia.
The features indicating a delirium include:
Q: What additional information would be helpful in the initial evaluation of this patient?
A: It would be important to try and identify a friend or caregiver to provide additional history. At a minimum, it would be useful to know:
Basic laboratory studies at this point might include a complete blood count with differential, serum electrolytes, blood urea nitrogen and creatinine, glucose, calcium, and liver function tests; a urinalysis and chest X-ray might help to rule out an infectious etiology.
Blood alcohol level, thyroid function testing and tox screen might be useful if the cause remains unclear.
Brain imaging is most helpful if there is a history of head trauma or focal neurologic findings on exam, but is probably not indicated in the initial evaluation of this patient.
Copyright 1999, 2000 David A. Gruenewald, M.D. and Kayla I. Brodkin, M.D. All rights reserved.