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Chapter 5 - Coma, Delirium, and Dementia

from Section 2 - Common Neurologic Presentations: A Symptom-Based Approach

Published online by Cambridge University Press:  10 January 2024

Thomas P. Campbell
Affiliation:
Allegheny Health Network, Pittsburgh
Kevin M. Kelly
Affiliation:
Allegheny Health Network, Pittsburgh
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Summary

Alterations in mental status are a frequently encountered chief complaint that the emergency physician is asked to evaluate. These changes vary from marked depression of mental status to extreme over-activation. The differential diagnosis of altered mental status (AMS) is perhaps one of the broadest encountered in medicine. Here we will discuss alterations in mental status, and a diagnostic approach to these types of patients.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

ACEP, AGS, ENA, SAEM, Geriatric Emergency Department Guidelines Task Force. Geriatric emergency department guidelines. Ann Emerg Med 2014;63(5):e725.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. APA Press, 2013.Google Scholar
Arena, JE, Rabinstein, AA. Transient global amnesia. Mayo Clin Proc 2015;90(2):264272.Google Scholar
Balestreri, M, Szonskya, M, Chatfield, DA, et al. Predictive value of the Glasgow Coma Scale after brain trauma: change in trend over the past ten years. J Neurol Neurosurg Psych 2004;75:161162.Google Scholar
Bartsch, T, Butler, C. Transient amnesic syndromes. Nature Rev Neur 2013;9:8697.Google Scholar
Brown, J. ED Evaluation of transient global amnesia. Ann Emerg Med 1997;30(4):522526.Google Scholar
Carpenter, CR, DesPain, B, Keeling, TN, et al., The Six-Item Screener and AD8 for the detection of cognitive impairment in geriatric emergency department patients. Ann Emerg Med 2011;57(6):653661.Google Scholar
Doebbeling, CC. Behavioral emergencies. In Merck Manuals Professional Edition. 2008. Available at www.merckmanuals.com/professional/psychiatric-disorders/approach-to-the-patient-with-mental-symptoms/behavioral-emergencies. Accessed June 5, 2018.Google Scholar
Edlow, JA, Rabinstein, A, Traub, SJ, Wijdicks, EF. Diagnosis of reversible causes of coma. Lancet 2014;384:20642076.Google Scholar
Fong, T, Davis, D, Growdon, MA, et al. The interface between delirium and dementia in elderly adults. Lancet 2015. http://dx.doi.org/10/1016/S1474-4411(15)00101-5.Google Scholar
Greer, DM, Yang, J, Scripko, PD, et al., Clinical examination for outcome prediction in nontraumatic coma. Crit Care Med 2012;40:11501156.Google Scholar
Horsting, MWB, Franken, MD, Meulenbelt, J, et al. The etiology and outcome of non-traumatic coma in critical care: a systematic review. BMC Anesthesiol 2015;15:6572.Google Scholar
Inouye, SK, Westendrop, RG, Saczynski, JS. Delirium in elderly people. Lancet 2014;383:911922.Google Scholar
Kales, HC, Gitlin, LN, Lyketsos, CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ 2015;350:h369.Google Scholar
Kalish, VB, Gillham, JE, Unwin, BK. Delirium in older persons: evaluation and management. Am Fam Phys 2014;90(3):150158.Google ScholarPubMed
Knopman, DS, DeKosky, ST, Cummings, JL, et al. Practice parameter: diagnosis of dementia. An evidence based review. Neurology 2001;56:11431153.Google Scholar
Moore, SA, Wijdicks, EF. The acutely comatose patient: clinical approach and diagnosis. Sem Neurol 2013;33:110120.Google Scholar
Saitman, A, Park, H-D, Fitzgerald, RL. False-positive interferences of common urine drug screen immunoassays: a review. J Anal Toxicol 2014;38(7):387396.CrossRefGoogle ScholarPubMed
Samaras, N, Chevalley, T, Samaras, D. et al. Older patients in the emergency department: a review. Ann Emerg Med 2010;56(3):261269.CrossRefGoogle ScholarPubMed
Scheel, M, Malkowsky, C, Klingebiel, et al. Magnetic resonance imaging in transient global amnesia. Clin Neurorad 2012;22:335340.CrossRefGoogle ScholarPubMed
Tokuda, Y, Nakazato, N, Stein, GH. Pupillary evaluation for differential diagnosis of coma. Postgrad Med J 2003;79:4951.CrossRefGoogle ScholarPubMed
Weisberg, LA, Garcia, C, Strub, R. Stupor and coma. In Essentials of Clinical Neurology. 2015. Available at: http://tulane.edu/som/departments/neurology/programs/clerkship/essentials-clinical-neurology.cfm. Accessed August 15, 2015.Google Scholar
Wijdicks, EFM, Bamlet, WR, Maramattom, BV et al. Validation of a new coma scale: the FOUR score. Ann Neurol 2005;58(4):585593.Google Scholar
Wilber, ST, Lofgren, SD, Mager, TG et al. An evaluation of two screening tools for cognitive impairment in older emergency department patients. Acad Emerg Med 2005;12:612616.Google Scholar
Wong, CL, Holroyd-Leduc, J, Simel, DL, Straus, SE. Does this patient have delirium? JAMA 2010;304:779786.Google Scholar

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