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smithy

dementia diagnosis

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According to ICD-10 in dementia, consciouness is not clouded. (p45)

1) how can one be certain clouding is not present?

Consciousness is awarness of self and enviroment. This means that in clouding there is impairment of a persons ability to feel or percieve their enviroment. How the heck to you assess this. And how do you record you findings to communicate your assessment to others? If you take clouding to mean impairment of orientation, and memory, well then you get back to the diagnosis of dementia. &nbsp:lol:oes ability to shift focuss of attention play a role in the assessment? If so how can you assess this?

2) late stages of dementia are very similar to delirium (as view as a snapshot anyway) in delirium there is clouding. &nbsp:lol:oes this mean that ICD is incorrect?

Help

My head hurts

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It is tricky- the drawback of having a categorical classification like ICD-10. And you are more likely to have an underlying dementia if you are delerious. For dementia, think MMSE; for delerium, think GCS! It boils down to orientation, attention and concentration, and fluctuation, I think.

And yes, ICD-10 IS wrong- we just don't know which bits of it!

Anyone in older adults out there?

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I agree with ROs...

Conciousness is measured using GCS... so... if the patient is not comatose or stuporous, he is concious

Awareness of oneself and surrounding will also translate to orientation...

In orientation, the orientation to time goes first, then to place and then to person... So if a person cannot identify a nurse, then most probably he is also not oriented to time and place... and when he is improving, it comes back in the reverse order... first person, then place and then time

Orientation disappears quite late in dementia... so does attention... so doing a serial 7/serial 3 will be impaired in delirium...

Another domain of importance will be the mode of onset...

If there is a sudden/ acute decline in cognitive funtion, it is more likely to be an acute confusional state.

But it is very difficult to diagnose delirium in severe dementia... in which case, we probably find the patient more confused, and we do look for signs of physical illness because thats the most common cause (apart from medication)

See... I am concious... but i was unaware that I was ranting.... that puts me in a state of perpetual dissociation

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In general the above discussion holds good. But If we look at specific types especially DLB attention,concentration are impaired quite early and ofen before recall is lost. Delirium in a patient admitted for physical complaints associated with parkinson's disease often is the first sign of a Lewybody disease.

Delirium in advanced dementia is difficult to diagnose. There lies the importance of a good history and use of instruments like Bristol ADL scale and NPI(Q). A sudden change or rapid loss of abilities along with physical signs and investigations is vital.

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