Intent:
To record behavioral signs that may indicate that delirium is present. Frequently, delirium is caused by a treatable illness such as an infection or a reaction to medications.
The characteristics of delirium are often manifested behaviorally and therefore can be observed. For example, disordered thinking may result in rambling, irrelevant, or incoherent speech.
A recent and perhaps rapid deterioration in cognitive function is likely indicative of delirium (an acute confusional state), which may be reversible if detected and treated in a timely fashion. Signs of delirium can be easier to detect in a person with intact cognitive function at baseline. When a person has a pre-existing cognitive impairment or pre-existing behaviours such as restlessness, calling out, etc., detecting signs of delirium is more difficult. Despite this difficulty, it is possible to detect signs of delirium by being attuned to recent changes in the person’s usual functioning. For example, a person who is usually noisy or belligerent may suddenly become quiet, lethargic, and inattentive. Conversely, one who is normally quiet and content may suddenly become restless and noisy.
Definitions:
Easily distracted — e.g., episodes of difficulty paying attention; gets sidetracked.
Episodes of disorganized speech — e.g., speech is nonsensical, irrelevant, or rambling from subject to subject; loses train of thought.
Mental function varies over the course of the day — e.g., sometimes better, sometimes worse; behaviors sometimes present, sometimes not.
Process:
Ask the person or others who know the person if any of the behaviours have been noticed over the last 3 days. If the response is yes, determine if the behavior is different from the person’s normal functioning.
Coding:
Code for the person’s behavior in the last three days regardless of what you believe the cause to be, focusing on when the manifested behavior first occurred and whether it is different than the person’s usual pattern.
0. Behavior not present
1. Behavior present, consistent with usual functioning
2. Behavior present, appears different from usual functioning (e.g., new onset or worsening, different from a few weeks ago)
Examples of How to Code Indicators of Periodic Disordered Thinking/Awareness
Tom was observed to have
episodes of rambling speech on two of the last three days. This
behavior has been present for some time and has not changed in approximate
frequency. It occurs during the day and evening; Tom generally
sleeps through the night. He is able to attend to conversations with
his caregiver, however.
Code=1 for “Episodes” and 0 for all other items
Mr. Smith has been observed
to be picking at his clothing when he is spoken to and rambles incoherently
whenever he is awake. These are new behaviors according to his family.
Code=2 for “Easily distracted” and “Episodes” and 0 for “Mental”