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This article appeared in The Home News Tribune Online on December 4, 2007.
Dementia, delirium and depression: Three D's with some big differences
By Debra Ciuba, MSN, RN, BC and Roxane Skolsky, MA, RN, BC
Correspondents
A woman was brought to the hospital's Emergency Department because she had taken too many anti-anxiety medications. The woman's family described their mother as becoming more forgetful, and they were sure she was suffering from dementia. They assumed her overdose was due to her increasing forgetfulness.
When we interviewed the woman, she denied she was forgetful. She told us that she had been having trouble sleeping and the medicine would help her sleep.
The woman was checked medically by the Emergency Department physician. We wanted to make sure there were no infections, no heart rhythm disturbances, no thyroid or kidney problems, all of which can present as dementia in an older person.
Medically, the woman was healthy. We recommended that she be seen by the psychiatrist. We did this because we suspected that rather than dementia, the woman may be suffering from depression.
Depression is sometimes difficult to diagnose because it can take on many guises. A depressed person can have the classic symptoms of apathy, helplessness or hopelessness, but he or she can also exhibit problems concentrating. Unexplained changes in weight can be a symptom of depression. A person with depression may have problems sleeping or eating, may be easily distracted, have difficulty concentrating or staying on task.
Dementia, delirium and depression have some major differences, but sorting them out takes time. You need to do a complete medical and psychiatric workup and take a thorough history from the patient and family.
Dementia is not a normal part of aging. A number of medical conditions can have dementia as a symptom. Some of those include vascular problems, thyroid problems, infections and dehydration. Parkinson's disease can include dementia as a symptom. Some cardiac, sleep, asthma and over-the-counter medications, such as sinus or nighttime cold remedies also can cause behavior changes.
The key difference between delirium and dementia is the duration of the disorder. Delirium is temporary. It can be brought on by disease, trauma or intoxication. For example, patients in the Intensive Care Unit can become delirious due to several factors including anesthesia, abnormal blood tests, medications or even the busy environment around them of bright lights and noise 24 hours a day. However, they can become clear-headed as their condition resolves. Delirium is characterized by loss of attention. Recent memory and thinking can be disorganized and cloudy.
Dementia's onset is more gradual and can be permanent. The person can have problems with attention and memory, both recent and remote. A person with dementia may be able to tell you what he did in the military service during World War II, but can't tell you what he had for breakfast today, remember to shut the windows in the rain or identify a loved one. People with dementia may have difficulty forming words and their speech may not make sense.
Depression can come on suddenly and last weeks or even years. Melancholy, sadness or feelings of worthlessness are not the only symptoms of depression. Others may include poor concentration, changes in sleep and appetite, fatigue and selective memory, such as recalling only bad events during a lifetime. Loss of pleasure and thoughts about death, including suicide, are other features.
A past history of depression, a family history of the disease, as well as major life changes all can contribute to the occurrence of depression. And it is not, as many believe, a normal consequence of aging.
In our patient's case, the psychiatrist discovered that the woman, who was in her 60s, had recently experienced some major life changes. The psychiatrist learned that she had recently retired from a job she held for 30 years. The woman and her husband had also sold their home and moved into a new house in a seniors-only community. With a new home and her retirement, the patient was concerned about money, which caused her anxiety. The psychiatrist also learned that many years ago, the woman had suffered a depression that was never treated.
With these stressors in her life, plus her untreated depression of years ago, depression, not dementia, was the diagnosis. The psychiatrist prescribed antidepressants and explained to the woman's children that their mother was suffering from depression, a disease that could be treated.
Debra Ciuba, MSN, RN, BC and Roxane Skolsky MA, RN, BC, are psychiatric nurse clinicians for the Psychiatric Emergency Service Department at Robert Wood Johnson University Hospital Rahway. Skolsky will be giving a lecture on Holiday Blues, Wednesday, at 11 a.m., at the RWJ Rahway Fitness & Wellness Center, at 2120 Lamberts Mill Road in Scotch Plains. To register for the free lecture please call (732) 499-6193.
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