Altered mental status (geriatrics) - Revision history

Danbot: Strip excess bold

2026-03-22T09:26:03Z

Strip excess bold

← Revisión anterior		Revisión del 09:26 22 mar 2026
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	==Infectious==		==Infectious==
	~~'''~~[[Encephalitis]]~~'''~~		[[Encephalitis]]
	*Mental status changes - personality/behavior changes		*Mental status changes - personality/behavior changes
	*Unlikely to have [[fever]]s, meningismus		*Unlikely to have [[fever]]s, meningismus
	*High risk: same for meningitis, live near water		*High risk: same for meningitis, live near water

	~~'''~~[[Meningitis]]~~'''~~		[[Meningitis]]
	*Usually other etiology for altered mental status, but if negative workup do LP		*Usually other etiology for altered mental status, but if negative workup do LP
	*Consider [[Ampicillin]] for [[listeria]]		*Consider [[Ampicillin]] for [[listeria]]
Línea 17:		Línea 17:
	*High risk: [[HIV]], [[DM]], malignancy, s/p [[ceftriaxone]], prior neurosurgery, [[alcoholism]], recent [[sinusitis]]		*High risk: [[HIV]], [[DM]], malignancy, s/p [[ceftriaxone]], prior neurosurgery, [[alcoholism]], recent [[sinusitis]]

	~~'''~~[[Pneumonia]]~~'''~~		[[Pneumonia]]
	*False negative [[CXR]] ~15-20%		*False negative [[CXR]] ~15-20%
	*High morbidity		*High morbidity

	~~'''~~[[UTI]]~~'''~~		[[UTI]]
	*Very common etiology for altered mental status in elderly		*Very common etiology for altered mental status in elderly
	*Straight cath [[UA]]		*Straight cath [[UA]]
Línea 27:		Línea 27:
	*High risk: pelvic relaxation, indwelling foley >2wks (check for one!), BPH, history prostate cancer		*High risk: pelvic relaxation, indwelling foley >2wks (check for one!), BPH, history prostate cancer

	~~'''~~[[Cholecystitis]]~~'''~~		[[Cholecystitis]]
	*May not have [[RUQ pain]] or GI symptoms		*May not have [[RUQ pain]] or GI symptoms
	*Ask about history of gallstones/[[RUQ Ultrasound\|US RUQ]]		*Ask about history of gallstones/[[RUQ Ultrasound\|US RUQ]]

	~~'''~~Skin/Soft Tissue~~'''~~		Skin/Soft Tissue
	*Completely undress to examine		*Completely undress to examine
	*Often [[decubitus ulcers]] present		*Often [[decubitus ulcers]] present
Línea 39:		Línea 39:
	==Metabolic/Toxic/Polypharmacy==		==Metabolic/Toxic/Polypharmacy==

	~~'''~~Withdrawal/Overdose~~'''~~		Withdrawal/Overdose
	*Chronic [[opioid]]/[[benzodiazepine]]/[[zolpidem]] (Ambien) use		*Chronic [[opioid]]/[[benzodiazepine]]/[[zolpidem]] (Ambien) use
	*[[ETOH abuse]] - may not experience [[tremor]]s in [[ETOH withdrawal]]		*[[ETOH abuse]] - may not experience [[tremor]]s in [[ETOH withdrawal]]

	~~'''~~Polypharmacy~~'''~~		Polypharmacy
	*[[NSAIDS]] - may be taking multiple		*[[NSAIDS]] - may be taking multiple
	**Long term [[ASA]]		**Long term [[ASA]]
Línea 53:		Línea 53:


	~~'''~~Other~~'''~~		Other
	*[[Cardiac Ischemia]] - no chest pain needed		*[[Cardiac Ischemia]] - no chest pain needed
	*[[Seizure]] v Post ictal		*[[Seizure]] v Post ictal

ClaireLewis at 20:34, 1 October 2019

2019-10-01T20:34:13Z

← Revisión anterior		Revisión del 20:34 1 oct 2019
Línea 8:		Línea 8:
	'''[[Encephalitis]]'''		'''[[Encephalitis]]'''
	*Mental status changes - personality/behavior changes		*Mental status changes - personality/behavior changes
	*Unlikely to have ~~fevers~~, meningismus		*Unlikely to have [[fever]]s, meningismus
	*High risk: same for meningitis, live near water		*High risk: same for meningitis, live near water

Línea 15:		Línea 15:
	*Consider [[Ampicillin]] for [[listeria]]		*Consider [[Ampicillin]] for [[listeria]]
	*Consider [[acyclovir]] for [[HSV]]		*Consider [[acyclovir]] for [[HSV]]
	*High risk: [[HIV]], [[DM]], malignancy, s/p [[ceftriaxone]], prior ~~NSG~~, [[alcoholism]], recent [[sinusitis]]		*High risk: [[HIV]], [[DM]], malignancy, s/p [[ceftriaxone]], prior neurosurgery, [[alcoholism]], recent [[sinusitis]]

	'''[[Pneumonia]]'''		'''[[Pneumonia]]'''
	*False negative CXR ~15-20%		*False negative [[CXR]] ~15-20%
	*High morbidity		*High morbidity

	'''[[UTI]]'''		'''[[UTI]]'''
	*Very common etiology for altered mental status in elderly		*Very common etiology for altered mental status in elderly
	*Straight cath UA		*Straight cath [[UA]]
	*Resistant organisms likely, look up old urine culture + ~~sensetivity~~		*Resistant organisms likely, look up old urine culture + sensitivity
	*High risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, history prostate cancer		*High risk: pelvic relaxation, indwelling foley >2wks (check for one!), BPH, history prostate cancer

	'''[[Cholecystitis]]'''		'''[[Cholecystitis]]'''
	*May not have RUQ pain or GI symptoms		*May not have [[RUQ pain]] or GI symptoms
	*Ask about history of gallstones/US RUQ		*Ask about history of gallstones/[[RUQ Ultrasound\|US RUQ]]

	'''Skin/Soft Tissue'''		'''Skin/Soft Tissue'''
Línea 41:		Línea 41:
	'''Withdrawal/Overdose'''		'''Withdrawal/Overdose'''
	*Chronic [[opioid]]/[[benzodiazepine]]/[[zolpidem]] (Ambien) use		*Chronic [[opioid]]/[[benzodiazepine]]/[[zolpidem]] (Ambien) use
	*[[ETOH abuse]] - may not experience ~~tremors~~ in [[ETOH withdrawal]]		*[[ETOH abuse]] - may not experience [[tremor]]s in [[ETOH withdrawal]]

	'''Polypharmacy'''		'''Polypharmacy'''
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	*[[Cardiac Ischemia]] - no chest pain needed		*[[Cardiac Ischemia]] - no chest pain needed
	*[[Seizure]] v Post ictal		*[[Seizure]] v Post ictal
	*Urinary retention - uremia		*[[Urinary retention]] - [[uremia]]
	*Fecal impaction		*[[Fecal impaction]]
	*Occult [[mesenteric]] ~~ischemia~~		*Occult [[mesenteric ischemia]]
	*[[Electrolyte abnormalities]] (e.g. Ca/Mg/Phos)		*[[Electrolyte abnormalities]] (e.g. Ca/Mg/Phos)

Línea 64:		Línea 64:
	*[[Altered Mental Status]]		*[[Altered Mental Status]]
	*[[Geriatrics (Main)]]		*[[Geriatrics (Main)]]
			*https://www.aliem.com/2013/08/a-time-based-approach-to-elderly-patients-with-altered-mental-status/

	==References==		==References==
Línea 72:		Línea 73:
	[[Category:Neurology]]		[[Category:Neurology]]
	[[Category:Misc/General]]		[[Category:Misc/General]]
			[[Category:Symptoms]]

Ostermayer at 18:33, 23 April 2019

2019-04-23T18:33:51Z

← Revisión anterior		Revisión del 18:33 23 abr 2019
Línea 33:		Línea 33:
	'''Skin/Soft Tissue'''		'''Skin/Soft Tissue'''
	*Completely undress to examine		*Completely undress to examine
	*Often decubitus ulcers present		*Often [[decubitus ulcers]] present
	**Old photos helpful		**Old photos helpful
	*Consider fistula, [[osteomyelitis]], [[necrotizing fasciitis]]		*Consider fistula, [[osteomyelitis]], [[necrotizing fasciitis]]

ClaireLewis at 01:44, 27 January 2019

2019-01-27T01:44:37Z

← Revisión anterior		Revisión del 01:44 27 ene 2019
Línea 3:		Línea 3:
	*Unique aspects of elderly altered mental status		*Unique aspects of elderly altered mental status
	*See [[altered mental status]] for complete differential list		*See [[altered mental status]] for complete differential list
	*Dementia should be diagnosis of exclusion		*[[Dementia]] should be diagnosis of exclusion

	==Infectious==		==Infectious==
	'''Encephalitis'''		'''[[Encephalitis]]'''
	*Mental status changes - personality/behavior changes		*Mental status changes - personality/behavior changes
	*Unlikely to have fevers, meningismus		*Unlikely to have fevers, meningismus
	*High risk: same for meningitis, live near water		*High risk: same for meningitis, live near water

	'''Meningitis'''		'''[[Meningitis]]'''
	*Usually other etiology for altered mental status, but if negative workup do LP		*Usually other etiology for altered mental status, but if negative workup do LP
	*Consider [[Ampicillin]] for listeria		*Consider [[Ampicillin]] for [[listeria]]
	*Consider acyclovir for HSV		*Consider [[acyclovir]] for [[HSV]]
	*High risk: HIV, DM, malignancy, s/p [[ceftriaxone]], prior NSG, alcoholism, recent sinusitis		*High risk: [[HIV]], [[DM]], malignancy, s/p [[ceftriaxone]], prior NSG, [[alcoholism]], recent [[sinusitis]]

	'''Pneumonia'''		'''[[Pneumonia]]'''
	*False negative CXR ~15-20%		*False negative CXR ~15-20%
	*High morbidity		*High morbidity

	'''UTI'''		'''[[UTI]]'''
	*Very common etiology for altered mental status in elderly		*Very common etiology for altered mental status in elderly
	*Straight cath UA		*Straight cath UA
Línea 27:		Línea 27:
	*High risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, history prostate cancer		*High risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, history prostate cancer

	'''Cholecystitis'''		'''[[Cholecystitis]]'''
	*May not have RUQ pain or GI symptoms		*May not have RUQ pain or GI symptoms
	*Ask about history of gallstones/US RUQ		*Ask about history of gallstones/US RUQ

	'''Skin/Soft Tissue'''		'''Skin/Soft Tissue'''
	*~~Completly~~ undress to examine		*Completely undress to examine
	*Often ~~decubs~~ present		*Often decubitus ulcers present
	**Old photos helpful		**Old photos helpful
	*Consider fistula, ~~osteo~~, necrotizing		*Consider fistula, [[osteomyelitis]], [[necrotizing fasciitis]]

	==Metabolic/Toxic/Polypharmacy==		==Metabolic/Toxic/Polypharmacy==

	'''~~Withdrawl~~/Overdose'''		'''Withdrawal/Overdose'''
	*Chronic ~~opiate~~/~~Benzo~~/Ambien use		*Chronic [[opioid]]/[[benzodiazepine]]/[[zolpidem]] (Ambien) use
	*~~EtOH~~ abuse - may not experience tremors in withdrawal		*[[ETOH abuse]] - may not experience tremors in [[ETOH withdrawal]]

	'''Polypharmacy'''		'''Polypharmacy'''
	*NSAIDS - may be taking multiple		*[[NSAIDS]] - may be taking multiple
	**Long term ASA		**Long term [[ASA]]
	*Steroids		*[[Steroids]]
	*~~Sedative~~/Psychoactives		*[[Sedatives]]/Psychoactives
	*Anticholinergics - many OTC		*[[Anticholinergics]] - many OTC
	**Meperidine, cimetidine, ranitidine, TCAs, antiparkinson, antipsychotics, [[diphenhydramine]]		**[[Meperidine]], [[cimetidine]], [[ranitidine]], [[TCAs]], antiparkinson, [[antipsychotics]], [[diphenhydramine]]
	**Dietary - teas, supplements		**Dietary - teas, supplements


	'''Other'''		'''Other'''
	*Cardiac Ischemia - no chest pain needed		*[[Cardiac Ischemia]] - no chest pain needed
	*[[Seizure]] v Post ictal		*[[Seizure]] v Post ictal
	*Urinary retention - uremia		*Urinary retention - uremia
	*Fecal impaction		*Fecal impaction
	*Occult mesenteric ischemia		*Occult [[mesenteric]] ischemia
	*Ca/Mg/Phos		*[[Electrolyte abnormalities]] (e.g. Ca/Mg/Phos)

	==See Also==		==See Also==

Rossdonaldson1: Text replacement - "Seizure " to "Seizure "

2016-09-25T21:58:55Z

Text replacement - "*Seizure " to "*Seizure "

← Revisión anterior		Revisión del 21:58 25 sep 2016
Línea 55:		Línea 55:
	'''Other'''		'''Other'''
	*Cardiac Ischemia - no chest pain needed		*Cardiac Ischemia - no chest pain needed
	*Seizure v Post ictal		*[[Seizure]] v Post ictal
	*Urinary retention - uremia		*Urinary retention - uremia
	*Fecal impaction		*Fecal impaction

Rossdonaldson1: Text replacement - " diphenhydramine" to " diphenhydramine"

2016-08-03T23:41:17Z

Text replacement - " diphenhydramine" to " diphenhydramine"

← Revisión anterior		Revisión del 23:41 3 ago 2016
Línea 49:		Línea 49:
	*Sedative/Psychoactives		*Sedative/Psychoactives
	*Anticholinergics - many OTC		*Anticholinergics - many OTC
	**Meperidine, cimetidine, ranitidine, TCAs, antiparkinson, antipsychotics, diphenhydramine		**Meperidine, cimetidine, ranitidine, TCAs, antiparkinson, antipsychotics, [[diphenhydramine]]
	**Dietary - teas, supplements		**Dietary - teas, supplements

Rossdonaldson1: Text replacement - "AMS" to "altered mental status"

2016-07-31T13:02:25Z

Text replacement - "AMS" to "altered mental status"

← Revisión anterior		Revisión del 13:02 31 jul 2016
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	==Background==		==Background==
	*Elderly patients present differently with common issues		*Elderly patients present differently with common issues
	*Unique aspects of elderly ~~AMS~~		*Unique aspects of elderly altered mental status
	*See [[~~AMS~~]] for complete differential list		*See [[altered mental status]] for complete differential list
	*Dementia should be diagnosis of exclusion		*Dementia should be diagnosis of exclusion

Línea 12:		Línea 12:

	'''Meningitis'''		'''Meningitis'''
	*Usually other etiology for ~~AMS~~, but if negative workup do LP		*Usually other etiology for altered mental status, but if negative workup do LP
	*Consider [[Ampicillin]] for listeria		*Consider [[Ampicillin]] for listeria
	*Consider acyclovir for HSV		*Consider acyclovir for HSV
Línea 22:		Línea 22:

	'''UTI'''		'''UTI'''
	*Very common etiology for ~~AMS~~ in elderly		*Very common etiology for altered mental status in elderly
	*Straight cath UA		*Straight cath UA
	*Resistant organisms likely, look up old urine culture + sensetivity		*Resistant organisms likely, look up old urine culture + sensetivity

Rossdonaldson1: Text replacement - "CA " to "cancer "

2016-07-30T11:54:47Z

Text replacement - "CA " to "cancer "

← Revisión anterior		Revisión del 11:54 30 jul 2016
Línea 25:		Línea 25:
	*Straight cath UA		*Straight cath UA
	*Resistant organisms likely, look up old urine culture + sensetivity		*Resistant organisms likely, look up old urine culture + sensetivity
	*High risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, history prostate CA		*High risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, history prostate cancer

	'''Cholecystitis'''		'''Cholecystitis'''

Rossdonaldson1: Text replacement - "UCx" to "urine culture"

2016-07-30T08:53:53Z

Text replacement - "UCx" to "urine culture"

← Revisión anterior		Revisión del 08:53 30 jul 2016
Línea 24:		Línea 24:
	*Very common etiology for AMS in elderly		*Very common etiology for AMS in elderly
	*Straight cath UA		*Straight cath UA
	*Resistant organisms likely, look up old ~~UCx~~ + sensetivity		*Resistant organisms likely, look up old urine culture + sensetivity
	*High risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, history prostate CA		*High risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, history prostate CA

Rossdonaldson1: Text replacement - "sxs" to "symptoms"

2016-07-18T17:19:14Z

Text replacement - "sxs" to "symptoms"

← Revisión anterior		Revisión del 17:19 18 jul 2016
Línea 28:		Línea 28:

	'''Cholecystitis'''		'''Cholecystitis'''
	*May not have RUQ pain or GI ~~sxs~~		*May not have RUQ pain or GI symptoms
	*Ask about history of gallstones/US RUQ		*Ask about history of gallstones/US RUQ