Establish baseline
Ask about usual function and onset using an appropriate collateral history.
MEDIVEERSETHE PRACTICAL HUBOBSERVE / REASON / EXPLAIN
Cognition and acute confusion
Explain a structured approach to cognition and new confusion.
Your practical station
An older patient has become newly confused since yesterday. Explain what you would establish before interpreting a cognitive score.
Recognise and interpret
Attention, arousal, orientation and time course help characterise cognitive change.
- Establish baseline
- Assess attention
- Escalate acute change
Assess attention
Use suitable bedside tasks, accounting for language, hearing and education.
Escalate acute change
New fluctuating confusion can signal an urgent underlying medical problem.
At the viva table
Try answering aloud, then open the suggested answer. Examiner questions vary.
01 / Does poor test performance alone diagnose dementia?
No. Assess context, baseline and reversible contributors.
02 / Why assess attention?
Impaired attention is important in delirium assessment.
03 / What does fluctuating mean?
Symptoms vary over time.
04 / Why review medicines?
Medicines can contribute to cognitive change.