01: Dementia, Delirium & Depression: Similarities, Differences, and Treatments

This program will help you to understand:

• The similarities and differences between dementia, delirium and depression
• The major treatments of them

• There are no easy answers when it comes to the care of another
• Our Hope is to offer you useful information and guidelines for caring for someone with dementia
• These guidelines will need to be adjusted to suit your own individual needs

Loss of mental functions (memory, thinking, and reasoning) caused by various forms of brain damage and diseases Common symptoms:

• Confusion about the date or time of day
• Repeatedly asking the same questions
• Inability to follow directions
• Becoming lost or disoriented in familiar places
• Lack of recognition or confusion about familiar people
• Difficulty with routine tasks such as paying the bills
• Personality changes
• Neglect of personal safety, hygiene, and nutrition
• Difficulty with coordination or balance
• Irreversible or reversible

A temporary state of confusion and disorientation that typically develops quickly and fluctuates Common symptoms:

• Reduced awareness of surroundings and events
• Delusions and hallucinations
• Confused, loud or belligerent speech
• Disorganized thought processes
• Bizarre behavior
• Fluctuating level of consciousness
• The sudden change is usually because something has happened to upset the body’s equilibrium

Causes:

• High fever
• Infections
• Medications
• Dehydration
• Toxins in the system (such as alcohol)
• Severe constipation or fecal impaction
• Unfamiliar surroundings or people

Mental disorder that typically presents with depressed mood Common symptoms

• Feeling depressed, sad or gloomy
• Loss of interest or pleasure
• Lack of energy, fatigue, or sluggishness
• Concentration or memory problems
• Feeling worthless or guilty
• Feeling helpless, discouraged, or hopeless
• Feeling overwhelmed or nervous
• Feeling irritable, restless, or anxious
• Appetite or weight changes
• Thoughts of death or suicide
• Sleep disturbances
• Aches and pains
• Diarrhea or constipation
• Older people are especially vulnerable to depression because of the many losses they experience
• Depression in the elderly can present with similar symptoms as dementia
• It is important to get a thorough evaluation by a healthcare professional

Though dementia, delirium and depression have many similar symptoms, they have different causes and different treatments

• Delirium: acute or abrupt onset over a few hours to a couple of days
• Depression: evolves over weeks to months
• Dementia: develops over many months to years

Delirium:

• Not capable of paying attention or concentrating at times
• Overall thinking is disorganized

Dementia:

• Attention and concentrate are impaired, but are able to focus and concentrate with proper engagement

Depression:

• Poor attention and concentration cause pseudo-dementia

• Can be seen with depression or dementia
• Dementia: less likely to show emotions and social engagement
• Depression: more likely to show facial expressions and engage socially

• Misinterpretation of visual and audio stimuli
• Common with delirium and dementia
• Less common with depression

Delirium:

• Difficulty with speech and understanding
• Incoherent, nonsense words and syllables
• Abusive language

Dementia:

• Gradual impairment of language and understanding

Depression:

• Slow and sparse language
• Able to understand and speak

Delirium:

• Can have frequent fluctuations of symptoms
• Short duration with treatment

Dementia:

• Typically gradual decline
• Can have fluctuations from time to time

Depression:

• Symptoms do not fluctuate much
• Treatable

Medical causes:

• Nutritional
• Hormonal
• Tumor-caused
• Drug-related
• Stroke

Alzheimer’s treatment:

• Control the symptoms
• Combination of medication, behavior therapy, psychotherapy, and environmental modifications.
• Cholinesterase inhibitors:

Donepezil (trade name Aricept®) Rivastigmine (trade name Exelon®) Galantamine (trade name Razadyne®)

• NMDA antagonist
• Memantine (trade name Namenda®)
• Combination therapy is more effective
• Managing behavior symptoms
• Medications
• Non-drug therapies first or in combination with drug therapy.

• Ginkgo biloba
• Vitamin E and other antioxidants
• NSAIDS (aspirin)
• Hormones
• Selegiline
• Blockers of plaque and tangles

• Effectors of brain metabolism
• Brain cell growth
• Immunizations
• Stem cells
• Risk factors

Behavioral approaches can reduce the frequency or severity of problem behaviors

• Break down complex tasks
• Reduce the amount of activity and noise in the environment
• Offer pleasurable activities

Modifying the environment for safety and comfort

• Remove hazards
• Childproof latches, doorknob covers, locks, Dutch doors, or covering doors
• Lower water temperature
• Install anti-scald devices
• Bed rails
• Safety rails or grab bars in bathrooms
• Simple décor
• Familiar objects

Click here for more info about strategies for managing challenging behaviors.

• Consult a physician
• Treat the underlying cause and manage symptoms
• Common causes include:
• Medications
• Drug or alcohol use
• Exposure to toxins
• Infections
• Dehydration
• Fecal impaction
• Worsening medical conditions (heart or lung disease)
• Fever
• Provide familiar people and objects

Main goal is safety of person and yourself

• Safety proof the environment
• Try to get the person to rest
• Reduce noises and distractions
• Use a calm, reassuring approach
• Provide information about who, what, where
• Speak slowly, calmly
• Repeat things
• Make eye contact, but do not touch
• Monitor until delirium resolves

What should Mary do to help him?

• A. Call him by his name, tell him who she is, and assure him that everything will be okay.
• B. Turn off the vacuum cleaner and move it out of his sight.
• C. Call his doctor.
• D. Take the toilet plunger away from Robert.
• E. A through C

Choice A: Call him by his name, tell him who she is, and assure him that everything will be okay is a good choice.

• Caregivers should stay calm, speak slowly and clearly, offer reassuring smiles and words, and repeat things.

Choice B: Turn off the vacuum cleaner and move it out of his sight is also a good choice.

• Things that can cause injury or distress should calmly be removed while telling the person what you are doing.

Choice C: Call his doctor is another good choice.

• Delirium is a medical emergency.

Choice D: Take the toilet plunger away from Robert is not a good choice.

• Robert may see this as a threat and respond with agitation or aggression.

Choice E: Because choice a through C are all good answers, E is the best choice.

• A combination of medication and non-drug therapies can treat depression quickly and effectively
• Treatments
• Physical care
• Healthy foods
• Counseling
• Medications
• Exercise
• Improves mood
• Improves muscle tone and flexibility
• Promotes diegestion
• Prevents constipation
• Improves heart and lung health

• Spend quality time
• Engage in social interactions
• Listen and provide comfort
• Provide mental stimulation
• Assist with daily needs
• Watch for signs of suicidal thoughts or plans
• Does the person ask 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?

Instructions:

• First, listen to the audio clip above
• Next, watch the video

• Individual counseling
• Behavioral therapy
• Cognitive therapy
• Reminiscing or life review therapy

Dementia, delirium and depression can present with similar symptoms and sometimes in the same person

DEMENTIA

• Gradual onset over months to years
• Typically worsens over years with only slight fluctuations
• Goal of treatment is to slow disease progression

DELIRIUM

• Acute onset (hours to a couple of days)
• Presents with dramatic behavior
• Frequent fluctuations in symptom severity
• Caused by an underlying health issue
• Reversible with proper treatment

DEPRESSION

• Develops over weeks to months
• Steady course until it is treated or resolves
• Treatments include medications, professional therapies, exercise, or support networks
• Be aware of suicide risk

Written by:

Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:

Sasha Asdourian

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