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Deconstructing and Differentiating the 3 D’s: Dementia, Delirium and Depression

Caring for an older adult is challenging and what can really make things confusing is when there is a sudden worsening in their behavior. It can be frightening and confusing and hard to tell what exactly is going on. In some instances, especially if you notice an acute worsening of cognition that is different from the baseline, you could be dealing with a delirious or depressive state on top of a baseline dementia, which if not recognized and treated, can result in poor health outcomes.

Delirium hits like a lightning bolt – sudden and often with serious consequences. It is a clinical syndrome characterized by an acute and often fluctuating cognitive condition and a markedly decreased attention span. The senior may become suddenly agitated and aggressive or unusually lethargic or somnolent and sometimes they can fluctuate between the two. There are many different reasons a senior may become delirious and the most common is a response to an infection, like  pneumonia or a urinary tract infection. If a new medication has been started and there is a sudden cognitive change, a drug-induced delirium is likely. Sensory overload and sleep deprivation – two common phenomena associated with emergency room visits and hospital stays, are also major contributors to this condition. Other factors include dehydration, metabolic imbalances or some sudden health event or trauma that is decreasing oxygen to the brain. The good news is that if the cause is identified and quickly treated, the condition is reversible.

Depression can often mimic dementia by causing changes in behavior like social withdrawal and even memory impairment. However, in a depressed state, you will notice a lot of “I don’t know’s,” sadness, and the senior will be bothered by the worsening memory impairment. In dementia, the mood can be normal, and while there may be significant memory impairment, the senior likely masks it or is not as bothered by it. The onset of dementia is slow and progressive. Depression occurs more rapidly. Differentiating a depression from a dementia is important as depression is a treatable condition.

Being a delirium and depression detective is a handy skill to master to treat potential conditions early and minimize hospitalizations. These are all skills that an Aging Life Care Professional® has in their toolbox. For more information on these three conditions, here’s a recent presentation I gave at The National Guardianship Association conference in Palm Springs earlier this year.

Written by Anne Sansevero