From the Guidelines
The diagnostic workup for altered mental status in the geriatric population should include a thorough medical history, physical examination, and laboratory tests to identify underlying causes such as infection, metabolic disorders, or neurological conditions.
Key Components of Diagnostic Workup
- Medical History: Assess for recent changes in medication, potential drug interactions, and underlying medical conditions that may contribute to altered mental status 1
- Physical Examination: Evaluate for signs of infection, trauma, or neurological deficits, and use validated assessment scales such as the Richmond Agitation Sedation Scale and Glasgow Coma Scale to quantify the severity of symptoms 1
- Laboratory Tests: Include complete blood count, blood chemistry, urinalysis, and electrocardiogram to identify potential underlying causes such as infection, metabolic disorders, or cardiac conditions 1
- Imaging Studies: Consider head computed tomography (CT) or magnetic resonance imaging (MRI) if there is suspicion of intracranial pathology, focal neurologic deficit, or trauma 1
Special Considerations
- Delirium: A common cause of altered mental status in the geriatric population, delirium is a medical emergency that requires early detection and accurate diagnosis to reduce mortality 1
- Psychosis: New onset psychosis may be a separate subgroup under the altered mental status category, and its diagnosis and management should be guided by the underlying cause, whether primary or secondary 1
Evidence-Based Recommendations
- The yield of neuroimaging studies in patients with altered mental status is low, but it is essential to identify patients with acute intracranial pathology or focal neurologic deficit 1
- The use of validated assessment scales and laboratory tests can help identify underlying causes of altered mental status and guide management decisions 1
From the Research
Diagnostic Workup for Altered Mental Status
The diagnostic workup for altered mental status in the geriatric population involves a comprehensive evaluation to identify the underlying cause of the condition. The following steps are recommended:
- Initial assessment: A thorough medical evaluation and stabilization should occur in parallel with a mental status evaluation 2
- Identification of etiologies: The differential diagnosis of etiologies of delirium is extensive, and patients with delirium need thorough evaluations to determine the underlying causes of the delirium 2
- Laboratory tests: Laboratory tests such as complete blood count, blood chemistry, and urinalysis may be ordered to rule out underlying medical conditions 3
- Imaging studies: Imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) may be ordered to rule out structural brain lesions or other abnormalities 4
- Electroencephalography (EEG): EEG may be ordered to rule out nonconvulsive seizures, which can cause altered mental status 4
Common Etiologies of Altered Mental Status
The most common etiologies of altered mental status in the geriatric population include:
- Infection: Infection is one of the most common precipitants of delirium 5
- Pharmacological and toxicological factors: Medications and toxins can cause altered mental status 3
- Systemic and organic factors: Systemic illnesses such as hypoxia, hypoglycemia, and hypotension can cause altered mental status 3
- Neurological factors: Neurological disorders such as stroke, dementia, and Parkinson's disease can cause altered mental status 3
- Endocrine and metabolic factors: Endocrine and metabolic disorders such as hyperthyroidism and hypothyroidism can cause altered mental status 3
Importance of Prompt Evaluation and Treatment
Prompt evaluation and treatment of altered mental status are essential to decrease morbidity and mortality associated with the condition 3. Delayed diagnosis and treatment can lead to irreversible brain injury and increased risk of mortality 4. A systematic approach to the patient, including a thorough medical evaluation and stabilization, is crucial in identifying the underlying cause of altered mental status and providing appropriate treatment 2.