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Geriatric Giant
Fig 1. Hipocrates
INTRODUCTION
Cerebral glimatosis
Meningitis carcinomatous
ACS
Pathophysiology Unclear
Acetylcholine
deficiency
Brain oxidative
metabolic impairment
ACS
Increased brain cytokine
on acute illness
Fig 2. Pathogenesis of ACS
Table 1.
CLINICAL SYMPTOMS
Memory impairment
Global Cognitive
Perception disturbance
Impairment
Mind process disturbance
Psychomotor activities
impairment
Irrelevant
Early communication
Symptoms
Autoanamnesis
difficult to understand
CLINICAL SYMPTOMS: Subtype
phenomenon by Liptzin & Leukoff
Hyperactive subtype
Hypoactive subtype
Mixed subtype
CLINICAL SYMPTOMS
Incoherent thoughts
Labile emotions
Lingual disturbance
Illusion/delusion/hallucination
Sleep-awake cycles
Lack of concentration
Disoriented
Lack of memory
DIAGNOSIS
Acute
confusional
state
70% were
difficult to
diagnose
DIAGNOSIS
Armstrong et al
Margolis et al
Conscious disturbance
Cognitive changes
Orientation
Sleep disturbance
Perception disturbance
Speech impairment
Consciousness impairment
Psychomotor activities
Observation
TREATMENT
Average treatment
& mortality after 6
months were 36%
& 26%
Only 4% of patients
with delirium had
complete recovery
PROGNOSIS
Delirium is a death
independent predictor and
admission for >6 months is
Wesley
similar with patients with
et al coma, using mechanical
ventilator and given
sedatives and analgesics