Mr. White is a 72-year-old man, with a history of hypertension
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Mr. White is a 72-year-old man, with a history of hypertension, COPD and moderate dementia, who presents with 4 days of increased confusion, nighttime restlessness, visual hallucinations, and urinary incontinence. His physical exam is unremarkable except for tachypnea, a mildly enlarged prostate, inattentiveness, and a worsening of his MMSE score from a baseline of 18 to 12 today.
Mr. White’s presentation is most consistent with an acute delirium (acute change in cognition, perceptual derangement, waxing and waning consciousness, and inattention).
1. What is the most likely diagnosis to frequently cause acute delirium in patients with dementia?
2. What additional testing should you consider if any?
3. What are treatment options to consider with this patient?
A 72-year-old man with a history of hypertension, COPD, and moderate dementia presents with increased confusion, nighttime restlessness, visual hallucinations, and urinary incontinence for 4 days. Mr. White is evaluated by his primary care physician. His physical examination is unremarkable, save for tachypnea, a mildly enlarged prostate, inattentiveness, and a worsening of his MMSE score from a baseline of 18 to 12 today, which is a significant decrease from his baseline score of 18.
Mr. White’s clinical presentation is most consistent with acute delirium, according to the experts (acute change in cognition, perceptual derangement, waxing and waning consciousness, and inattention).
1. What is the most likely diagnosis in patients with dementia who experience frequent episodes of acute delirium?
2. What additional testing, if any, do you think you should do?
3. What are the treatment options that should be considered for this particular patient?
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