Thread by @WesElyMD

1/ In #COVID19, we must learn from #BRAIN masters Engel & Romano, who described #DELIRIUM to #DEMENTIA relationship in the 1950s! Here are my TOP 10 CLASSIC quotes from their famous 1959 article:
bit.ly/2SePA1a
 
#medtwitter #meded #tipsfornewdocs #neurology #geriatrics

2/ The problem of delirium is far from an academic one. Not only does the presence of #delirium often complicate and render more difficult the treatment of a serious illness, but also it carries the serious possibility of permanent irreversible brain damage.
 
#dementia #COVID

3/ The deficiencies in the education of many physicians ill equip them to recognize any but the most flagrant examples of delirium.
 
#A2Fbundle #tipsforolddocs

4/ The physician who is greatly concerned to protect the functional integrity of the heart, liver, and kidneys of his patient has not yet learned to have similar regard for the functional integrity of the brain. This is a serious and, perhaps, #tragic #omission.

5/ Equally important are varieties & expressions of depression in delirious pts. A patient who has previously experienced depression or is vulnerable to depression may respond to the perception of loss of his intellectual & mental functions with depression.

6/ In delirium, pts have difficulty focusing attention & screening out interfering perceptions, whether they arise from the external environment or within. Similarly, one notes a difficulty in marshaling one’s thoughts logically, coherently, & appropriately.

7/ Desired memories and associations seem less readily accessible and often undesired or inappropriate memories and associations appear in their place. The execution of appropriate behavior and speech encounters the same difficulties.

8/ With very mild delirium, such difficulties may be quite inapparent to the observer since, for the most part, they can be adequately overcome by heightened effort. Nonetheless the EEG at this point already will show some slowing.

9/ With further advance of the delirium, this state becomes more manifest. Now pts become unable to perform correctly, even w/ heightened effort & appear confused and even bewildered. Responses tend to be slow, uncertain, & often reveal errors in memory, retention, and recall.

10/ With more severe degrees of delirium, one sees a mental apparatus virtually stripped of all but the most primitive ego fxn. Personal & idiosyncratic characteristics of behavior of delirious pts will be determined by past development.

11/fin “Delirium is a unified syndrome, a syndrome of cerebral insufficiency.”
 
Colleagues, familiarity breeds complacency. Just because you see tons of delirious #COVID19 pts, doesn’t make it less dangerous.
 
#medtwitter #meded #tipsfornewdocs #neurology #geriatrics

Unroll @threadreaderapp this tweetorial of the Top 10 quotes (if that’s possible) from Engel and Romano’s famous 1959 paper on #Delirium and #Dementia, please.