What is the difference between delirium dementia and depression

Nevertheless, diagnosis is often delayed, and problems remain with recognition and documentation of delirium by healthcare providers. Although there are no definitive quantitative markers available to diagnose delirium, qualitative tools such as the Confusion Assessment Method CAM and modified Richmond Agitation and Sedation Scale have been validated.

Although it presents with an array of physical symptoms, depression is considered a disorder of mood. It is also called an affective disorder to signify that one of its key aspects is a disturbance of emotions or feelings Diamond, The diagnosis of depression depends on the presence of two cardinal symptoms: 1 persistent and pervasive low mood, and 2 loss of interest or pleasure in usual activities.

Depressive symptoms are judged to be of clinical significance when they interfere with normal activities and persist for at least 2 weeks, in which case a diagnosis of a depressive illness or disorder may be made Diamond, Depression has been associated with an increased risk of dementia in old age, but the mechanisms underlying this association are not well understood.

This is true even when depression occurred more than 10 years before the onset of dementia. A history of depression nearly doubles the risk of developing dementia. Vascular factors may play a role in depression and dementia. Cerebrovascular disease, hypertension, diabetes, and other vascular factors may cause both cognitive impairment and depression.

In the long-term care population, depression is both common and under-treated. Depressive illness is associated with increased mortality, risk of chronic disease, and the requirement for higher levels of supported care Jordan et al. Long-term care staff can play a key role in the detection, assessment, management, and ongoing monitoring of mental health disorders among those they care for.

However, staff members usually receive little training in mental health and often hold misconceptions about disorders such as depression and the behavioral and psychological symptoms of dementia. As a result, they have demonstrated poor skills in managing residents with these disorders Jordan et al. Pharmacologic interventions are targeted at alleviating depressive symptoms primarily to improve quality of life and improve function Nowrangi et al.

Randomized controlled trials have evaluated the use of imipramine Tofranil , citalopram Celexa , fluoxetine Prozac , sertraline Zoloft , and moclobemide with beneficial results.

Non-pharmacologic management of depression involves both patient-focused interventions as well as family and caregiver support. Medications, infection, dehydration, metabolic changes, fecal impaction, urinary retention, hypo- and hyperglycemia.

If a person with dementia has a sudden and dramatic change in behavior and mental functioning, she or he may have delirium, which is a serious medical issue. The physician will want to distinguish delirium from other conditions that can cause confusion, such as depression, schizophrenia, or worsening dementia.

The primary goals in the treatment of delirium are to treat the underlying cause and to decrease the symptoms. Common causes include medications, drug or alcohol use, exposure to toxins, infections, dehydration, fecal impaction, and worsening medical conditions, such as heart or lung disease.

Treating the underlying costs can take some time. For example, if a fever is causing the delirium, it will need to go down and the cause of the fever will need to be treated. If it is due to a medication interaction, the medication will need to be excreted from the system. If it is due to dehydration, the person will need to be rehydrated.

Medications such as antipsychotics or sedatives may be given to decrease the severity of the symptoms until the cause can be treated. The key is to recognize delirium so that the underlying cause can be identified and treated. If a visit to the physician or the emergency room is necessary, try to have familiar people clothing, objects, and sounds around the person to provide reassurance. In this regard, try to avoid transporting in an ambulance.

The family car is usually most familiar and comforting to the person. It is helpful to call family members or friends for help when possible. But if there is concern about harm or injury to anyone, call the emergency response team. Whatever the cause for the delirium, your first concern should be for the safety of the person and yourself. In a state of delirium, a person does not interpret the environment accurately and could harm self or others.

Therefore, having safety-proofed your house in advance is essential. Remove objects or equipment that could cause falls. Try to get the person to sit or lie down and relax. Delirious people may be easily distracted or upset, so try to reduce any distractions and noise around the person or escort the person to a quieter, calmer place.

If the person needs eyeglasses or hearing aids, be sure they are being worn to help reduce confusion and injuries. People experiencing delirium will be frightened; it is best to use a calm and reassuring approach. Place familiar pictures and objects nearby to help comfort and orient them. Use simple terms to talk to them and explain everything that is happening to them. Speak slowly and repeat things frequently, as they will have difficulty with concentration and understanding.

Try to make eye contact but do not touch them until you see that they recognize you and that their fear has been reduced. Even then, be cautious of sudden or aggressive behavior changes. Keep in mind that they are sick and not intentionally being difficult. Carefully monitor them until the delirium resolves. Though she may not know the reason why, Mary realizes that Robert is in a state of acute confusion and probably does not recognize her.

In a state of delirium, a person is frightened. Calm reassurance is needed to reduce this anxiety. Caregivers should stay calm, speak slowly and clearly, and offer reassuring smiles and words. She can smile, let him know that she is Mary, his wife, and reassure him that everything will be okay.

She will need to repeat things frequently, as his concentration and ability to understand are likely decreased. In a state of delirium, people may not able properly interpret their environment.

Robert may be frightened by the noise of the vacuum cleaner and reacting with defensive behavior. Or he may not notice the vacuum as a potential obstacle and could trip over it.

Anything in the environment that could cause injury or distress should calmly be removed while telling the person what you are doing and why you are doing it. Delirium is considered a medical emergency. A healthcare professional should be consulted to figure out the cause for this behavior and treat it.

Mary may be tempted to take the plunger from him; however, Robert may see this as a threat and respond with agitation or aggression. Keep in mind that the symptoms of delirium may fluctuate from minute to minute, so Robert may look at the plunger and wonder how it got there. Choice E: Because choice a through C are all good answers, E is the best choice in this case. Depression is a serious medical condition, but in most cases it is treatable.

Some people may partially or fully recover from their depression without professional treatment over time, or with a change of season or encouragement from loved ones. However, a combination of medication and non-drug therapies can help treat depression more quickly and effectively.

A gerontologist, psychiatrist, or other mental health professional can evaluate the person and decide if medication is indicated, and if so, which of the many types of antidepressants would be most helpful. A person who is depressed may not believe that anything will ever get better. That is part of the illness.

It is important to tell the person that depression is treatable. Physical care, exercise, healthy foods, counseling, and numerous medications have been very successful in treating depression. Even the depression associated with dementia.

If those with depression are given medication, they need to be informed about what side effects might be experienced and how long the medication may take to become effective. Of course, any medication and serious health issues must be monitored and controlled by healthcare professionals.

Physical exercise is an important and inexpensive way to help treat depression. Exercise promotes the natural production of mood elevating substances in the body. Any form of regular exercise such as walking, dancing, yoga, water aerobics, or chair exercises can help improve mood and overall health. Exercise increases blood flow to important organs and muscles, and improves the delivery of nutrients and oxygen.

It also promotes muscle tone and flexibility, improves digestion, prevents constipation, and improves heart and lung health, among other benefits. All of these benefits provide a sense of well-being so encourage exercise and even try exercising with the person.

If there are any health issues, consult a physician before starting an exercise program. People who are depressed will often retreat from others and focus on failures or losses, spending quality time with them and engaging them in social interactions can help relieve depression.

At the same time, listening and comforting them as they grieve or share their concerns can help them deal with their feelings. Playing games, singing, doing puzzles and other activities can not only be fun, they can also increase brain activity and the secretion of mood elevating substances. Activity should begin simply and move on to more challenging ones when their mood improves. Reading or talking about current events, such as reading a newspaper or magazine can be helpful, but it is important to include more positive events and items of general interest.

Severely depressed people might need help with daily functions and needs. Some depressed people may not eat and so efforts will need to be made to ensure adequate nutrition and hydration. If they are constipated, it is important to provide fluids and a fiber-rich diet to prevent the development of fecal impaction.

They may need reminders to attend to hygiene such as tooth brushing, bathing, and hair care. Proper grooming and other appearance-enhancing efforts may help to raise their spirits.

If it is necessary to provide physical assistance, the person should be encouraged to return to self-care as soon as possible. Suicide attempts are not uncommon with depression and other chronic illness, especially among the elderly. A person may be experiencing unbearable pain or suffering with no relief in sight. Or a person with a terminal illness may wish to spare family members the burden and expense of prolonged medical care and hospitalization.

The highest rate of suicide in this nation is among people age 65 or older. Therefore caregivers for those with dementia should watch for signs of suicidal thoughts and plans. Suicide attempts can be dramatic, as in the use of firearms or other highly lethal methods, but there are more subtle attempts to end life, such as gradually overdosing on medication or even refusing to eat or drink.

Ask yourself: Does the person asked about death, wills, or funeral arrangements? Is she or he obsessed with expenses? Does she or he hide medication or other potentially lethal objects or substances? If there is any indication of suicidal thoughts, caregivers can directly ask about their concerns.

Though suicide may seem a delicate subject to discuss, asking about it in a concerned and loving manner will not make the person take action.

Chances are that the person will feel relieved. Older people can often benefit from individual counseling, behavioral therapy, cognitive therapy, and reminiscing or life review therapy.

In individual counseling, the therapist will talk to the depressed person in a confidential and safe environment to figure out the core issues causing depression and assist in working through the problems that are affecting mood and everyday function.

Behavioral therapy consists of the therapist helping the person to practice problem-solving in a supportive atmosphere. Desired behaviors are reinforced, and undesirable behaviors are downplayed or ignored.

In cognitive therapy, the therapist works with a person to restructure negative thought processes. The therapist helps the individual to identify, utilize, and reinforce individual strengths, acquire new skills, and experience success. The therapy works to enable success no matter how small.

With each success, the person feels good. When they feel good, they can experience more success. This cycle lessons depression. In this way one acknowledges, accepts, and honors the life as lived. In summary, dementia, delirium, and depression can present with similar symptoms and sometimes together in the same person.

But it is important to distinguish the three because treatments and prognoses are very different. Dementia has a gradual onset over months to years and typically worsens over years with only slight fluctuations in the symptoms.

Delirium has an acute onset, hours to a couple of days, and presents with more dramatic behavior and frequent fluctuations in the severity of the symptoms. It is often caused by an underlying health issue and can be reversed with proper treatment. Depression develops over weeks to months and typically has a steady course.

There are many effective treatment options for depression, even in those with dementia. Treatments include medications, professional therapies, exercise, and support networks. Lastly, it is important to be aware of the risk of suicide among the elderly with depression or chronic illness. Usually reversible with treatment of the underl ying condition.

Distorted — illusions, hallucinations, delusions; difficulty distinguishing between reality and misperceptions. These conditions can appear identical, however, haloperidol, which may sometimes be used to manage delirium symptoms, can cause severe movement disturbances such as spasms or rigidity and can even be fatal to some patients with DLB. The presence of parkinsonism helps in differentiating DLB from delirium.

Gore, R. Vardy, and J. O'Brien, Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum? J Newurol Neurosurg Psychiatry, Skip to main content. Differential diagnosis - depression, delirium and dementia.