Altered Level of Consciousness Clinical Trial
Official title:
Documentation of Altered Mental Status
Altered mental status (AMS) is common in older patients. However there is a lack of standardization in the definition and documentation of this compliant. Different perception of AMS can cause negative impact on interpretation and obtaining scientific data. Although definition of AMS is so complicated, clinical documentation can be detected in these patients with AMS.
Basically, consciousness is the state of full awareness of the self and one's relationship to
the environment. There are 2 related areas of neurologic function that are connected to
consciousness: content (orientation and memory) and level (arousal and response to stimuli).
The mental changes are best looked for in terms of arousal, attention, alertness,
orientation, cognition, memory, affect, and perception. Arousal (level of consciousness) can
be detected by the Richmond Agitation and Sedation Scale. Others are related to content of
consciousness and can be evaluated by cognitive tests. After one month pilot study, the
investigators chose 5 features of content of consciousness due to easy applicable and
detectable;
1. Attention (counting numbers backwards from 20) (>1 error positive)
2. Cognition (disorganized thinking; meaningless speech, irrelevant explanations)
3. Perception (visual or auditory hallucinations)
4. Memory (3 items recall) (>1 error positive)
5. Orientation (day of week, month and year) (>1 error positive)
These features are also combination of six item screener test and delirium symptoms.
All elderly patients (65 aged and older) presented to the emergency department, will be
assessed according to these two methods; content and level of consciousness. And also, every
patient's baseline status of consciousness will be obtained from surrogates who knows the
patient best. All changes from patient's baseline status will be recorded. The investigators
will investigate how changes are reflected in the clinic.
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