Dementia, Delirium, and Depression Comparison

Each condition is a risk factor for the others

All others have similar presentations.

All three can be present at the same time.

DEMENTIA

DELIRIUM

DEPRESSION

DEFINITION

An organic mental disorder of acquired

and persistent impairment in multiple
areas of cognitive function including loss
of S.T./L/T. memory, without disturbance
of consciousness, which results in
impairment and decline in social and
occupational functioning.

A syndrome of transient and reversible

disturbance of consciousness with changes
in cognition and/or alteration of perception,
directly due to a general medical condition.
Usually of sudden onset.

Depressed mood that is abnormal for the

individual, present for most of the day, nearly
every day, sustained for a at least 2 weeks,
caused by biological, genetic and/or
psychosocial factors. Common symptoms in
elderly: impaired concentration, lack of
motivation and somatic complaints.

ONSET

Gradual

Acute and fluctuating

Variable

PREVELANCE

Very common

Common

40% in AD

TIME/COURSE

Long-approximately 7-8 years

Self-limiting 1-2 wks., or 3-6 mo.

Variable, recurrent, 1/3 remain chronic

CLINICAL PICTURE

Forgetfulness, S.T. memory loss,

Fluctuating cognition and inattention,

Depressed mood, tearfulness, anhedonia,

Depression/anxiety, changes in
personality, paranoia loss of executive
function, disorientation, anomia, agnosia,
aphasia, apraxia, L.T. memory loss,
hallucinations/delusions/agitation.

Disorientation, disordered thinking,

hallucinations, altered LOC< agitated or
quiet behavior, presence of a medical
condition or infection, abnormal lab
finding, med changes/interactions.

A change in appetite weight and sleep

patterns. Psychomotor agitation/retardation,
loss of energy/apathy, feelings of guilt,
hopelessness/worthlessness, impaired
concentration, death wish.

PROGNOSIS

Long term prognosis poor, but, many

effective interventions for symptoms.

Good, but, substantial comorbidity and

poor outcomes, 30% mortality

60-70% positive response, variable, depending

on several factors.

EVALUATION

R/O delirium/depression. MSE: influenced

by ed. Level 28-30=MCI, 22-28 early, 1021=middle, 0-9 late dementia. Obtain
collateral info, past hx. Obtain
psychiatric/neuro consult, MRI, PET if <65,
new onset or to R/O CNS changes

R/O dementia/depression/infection/pain.
Assess for med changes, drug-drug
interactions, SE. Obtain blood work, urine,
xray, EKG as indicated. Assess for event.
Precipitants. CAM (compliment alternative
medications).

R/O dementia/delirium assess labs; drug

levels, B12, folate, thyroid function. Geriatric
depression scale. Assess psychosocial factors;
adjustment. Losses, and coping abilities, past
hx of depression. Conference with family,
obtain psych evaluation.

TREATMENT

Treat comorbid illness/depression. Utilize

behavioral staff interventions, sensory &
event. Modifications. Pharm: cognitive
enhancers for early-middle stage. Short
term use of antipsychotics, mood
stabilizers to reduce agitation or
hallucinations. Limit prn psychotropic use.

Identify & treat primary acute disease

process. Optimize meds. Prevent
complications & utilize supportive
measures. Behavioral interventions to
remove factors that exacerbate confusion.
Initiate 1:1 for agitated hyperactive states.
Short term psychotropic med treatment.

6-9 mo of antidepressant therapy; to stabilize

& 3 years for maintenance based on frequency
& severity of symptoms and/or 1:1
psychotherapy if cognitively intact, ie,
MCI/early dementia. Augmentation with mood
stabilizers/anxiolytics if anxiety or agitation
present. ECT.