Delirium, Depression and Dementia – The 3 Ds

The 3-Ds!

Do you know the difference between the 3 D’s, Delirium, Depression and Dementia?

We often think a person has dementia because he has memory problems.

This is not what dementia is.

Memory loss of recent information is one of the first symptoms we usually see.

Dementia is a syndrome (or set of symptoms) caused by about 80 different reasons.

Alzheimer’s disease is the major disease we see in people living with dementia, but there are many other types of dementia, each with its own unique set of peculiarities.

Some dementia’s are reversible such as a tumors, negative drug reactions, malnutrition due to a lack of vitamin A, C, B-12 and folate, heart disease, arrhythmia’s, trauma, metabolic or endocrine disorders, depression, thyroid or hormonal problems.

Irreversible dementia’s cannot be reversed because the brain is dying.  The physical organ itself is shrinking.

The signs and symptoms of delirium, dementia and depression overlap and look quite similar.

When a person is treated for depression and does not respond, he should then be evaluated for dementia.

Knowing and understanding the subtle differences between dementia, depression and delirium helps you support your loved one with appropriate interventions and medications.

Many times delirium can look exactly like dementia and a person may be misdiagnosed and treated incorrectly, even by medical professionals.

Depression, Delirium and Dementia Look Alike

Depression, Delirium and Dementia often look alike, and can occur at the same time, complicating a proper diagnosis and treatment.  It is, therefore, important to recognize the differences so you can seek the appropriate treatment.

Signs and Symptoms of Delirium

Delirium presents suddenly, we call that acute, with symptoms of confusion and/or disturbance in attention, disorganized thinking with a possible decline in the level of consciousness.

There is usually an underlying cause of delirium which is most often a urinary tract infection, also known as UTI.

The person may be suffering from medication toxicity.  Symptoms may also be caused by some other illness.

These symptoms are all treatable and reversible. Symptoms may worsen at night.

Delirium is a state of mental confusion that may occur as a result of illness, surgery or with the use of some medications.

Delirium usually starts suddenly and can be frightening for the person experiencing it, as well as for those around them.

Some symptoms are common to delirium, irrespective of cause, while some are cause-specific.

Examples of symptoms include:

  • Diminished awareness of surroundings
  • Uncertainly about location
  • Inability to understand conversation and speak clearly
  • Vivid, often frightening dreams that continue once awake
  • Auditory hallucination
  • Agitation and restlessness
  • Fear that others are trying to cause harm
  • Feeling drowsy and slow
  • Sleeping during the day but being awake at night
  • Rapid mood swings that vary from scared and anxious to depressed or irritable
  • Confusion that worsens in the evenings

Causes and Risks Associated With Delirium

Delirium is fairly common among hospitalized patients, with around 1 in 10 having a period of delirium. Delirium is more common among older people, those with memory problems, in cases of dementia, after surgery, after brain injury and in those with poor hearing or vision.
Some of the most common causes of delirium include:

  • Infection of the bladder, chest or brain
  • Fever
  • Medication side effect
  • Dehydration
  • Liver or kidney problems
  • Cessation of drug or alcohol use
  • Major surgery
  • Epilepsy
  • Terminal illness

Treatment

If a person suddenly develops confusion or lethargy out of the blue, urgent medical attention should be sought. Often, the patient is too confused to tell the doctors about their condition and history is often taken from a family member or someone who knows the patient well.

Treatment is aimed at correcting the underlying cause. A UTI infection would be treated with antibiotics.

Signs and Symptoms of Depression

Depression is biological and affects a person’s feelings, behavior and thoughts.

Depression is a common but serious mood disorder that causes severe symptoms that affect how a person feels, thinks, and handles daily activities, such as sleeping, eating, or working.

To be diagnosed with depression, the symptoms must be present for at least two weeks.

You may see:

  • Crying
  • Sad feelings,
  • Changes in eating,
  • Loss of interest in activities,
  • Trouble sleeping,
  • Unable to make decisions,
  • Feelings of worthlessness
  • Low self-esteem

There is often a history of depression throughout the person’s lifetime and can become a risk factor later in life.  Approximately 20% of people over 65 present with symptoms of depression.  Many doctors jump to the depression diagnosis first!

Causes and Risk Factors Associated With Depression

Some forms of depression are slightly different, or may develop under unique circumstances, such as:

  • Persistent depressive disorder, (dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder can have episodes of major depression along with periods of less severe symptoms, that must last for two years to be considered persistent depressive disorder.
  • Perinatal depression is much more serious than the “baby blues” which are relatively mild depressive and anxiety symptoms that clear within two weeks after delivery of the baby that many women experience after giving birth. Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
  • Psychotic depression occurs when a person has severe depression plus some form of psychosis, a disturbing false fixed belief (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
  • Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
  • Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods which meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

Signs and Symptoms of Depression

If you see some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, it may be depression:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Not everyone who’s depressed feels every symptom. Some experience only a few symptoms while others experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their depression. The severity and frequency of symptoms and how long they last vary depending on the individual and his or her particular illness. Symptoms vary depending on the stage of the illness.

Treatment and Therapies

Depression, can be treated. The earlier that treatment begins the more effective it is. Depression is usually treated with medications, and or psychotherapy. If these treatments do not reduce symptoms, electro-convulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Medications

There are many medications that doctors use to treat depression. They may help improve the way the brain uses certain chemicals that control mood or stress. People usually have to try several different antidepressant medications before finding one that improves symptoms and has manageable side effects.  These medications take time but to work, up to 2-4 weeks before noting significant change. If on medication for depression it should not be abruptly stopped due to withdrawal symptoms. These must be tapered down with the help of a physician.

Signs and Symptoms of Dementia

Dementia presents gradually with a

  • Progressive decline in recent (short term) memory,
  • Slower processing of information that
  • Severe interference with ADLs (activities of daily life) by affecting
  • Communication,
  • Language,
  • Impaired Judgment,
  • Reasoning
  • Recent Memory issues
  • Inability to perform everyday activities.

Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, may occur after a stroke and is the second most common type of dementia. However, there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.

Dementia is often incorrectly referred to as “senility” or “senile dementia,” which reflects the formerly widespread but incorrect belief that serious mental decline is a normal part of aging.

Symptoms of dementia can vary greatly, but, at least two of the following core mental functions must be significantly impaired to be considered dementia:

  • Memory
  • Communication and language
  • Ability to focus and pay attention
  • Reasoning and judgment
  • Visual perception

There may be changes in mood, behavior and personality.

Dementia presents itself slowly, it is chronic and irreversible.

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God Bless you today and always…

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