Differentiating Among Depression Delirium And Dementia In Elderly Patients
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Elderly patients are at high risk for depression and cognitive disorders, the latter of which can be chronic or acute . Some patients have both affective and cognitive disorders. Clarifying the diagnosis is the first step to effective treatment, but this can be particularly difficult because elderly patients often have medical comorbidities that can contribute to cognitive and affective changes.
When evaluating elderly patients, it is important to assess cognitive status and determine their baseline ability to function and perform activities of daily living . ADLs relate to personal care including bathing or showering, dressing, getting in or out of bed or a chair, using the toilet, and eating . Instrumental activities of daily living include the individuals ability to prepare food, manage finances, shop for groceries, do housework, and use the telephone . Having a baseline for a patients ADLs and IADLs allows the physician to recognize and act upon changes. Though it is tempting to make assumptions based on a patients appearance, contacting family members or staff at the facility where a patient resides can provide valuable information about his or her cognitive and functional status that may otherwise be missed.
Going For An Assessment
The list of conditions and problems above isnt everything. Theres a whole range of things that can occasionally cause dementia-like symptoms for some people.
There isnt always a quick answer to the question, Is it dementia or something else? If someone has dementia-like symptoms, the most important thing to do is see their GP for a full assessment.
Differences Between Depression And Dementia
- Depression tends to develop much more quickly than most types of dementia over weeks or a few months.
- It is common for people with dementia to have problems with their speech and awareness of where they are and what time it is. This is unusual in depression.
- A person with depression may sometimes say they cant remember something but then remember when they are prompted. However, a person with dementia is likely not to remember recent events. They may also try to cover up their memory loss.
- A person with severe depression may have problems with their reasoning or memory. However, this is likely to be because they have poor concentration. Their problems with reasoning or memory should get better with treatment or when the depression lifts. This does not happen with dementia.
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Managing Depression In Dementia
Some suggestions for dealing with depression in a person with dementia include:
- Try to keep a daily routine for the person with dementia.
- Incorporate daily exercise, because this has been proven to have a positive impact on symptoms of depression.
- Limit the amount of noise and activity in the environment if this causes a problem. This will help avoid overstimulation.
- Large group situations can make some people feel worse, while others may benefit from the stimulation of a busy, active gathering. It is important to know what the person has enjoyed in the past, because it is likely that similar activities will still appeal.
- Have a realistic expectation of what the person can do. Expecting too much can make both the person with dementia and the carer feel frustrated and upset.
- Be aware of when the person is usually least tired and do any important tasks at that time.
- Be positive. Frequent praise will help both the person with dementia and the carer feel better.
- Include the person in conversation to the extent that they feel comfortable.
As A Care Worker How Can You Help
There are many conditions and circumstances where you may see signs and symptoms that may be confused with dementia. As a care worker, it is not your responsibility to try to diagnose the condition. However, as you may be the one person who sees the individual on a regular basis, you are well placed to notice any changes. Encouraging an older person to visit their GP on a regular basis can help them to maintain their general health and wellbeing.
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Memory Changes That Happen With Age
As we get older, our memory naturally starts to get a little worse. But there is a difference between these expected memory problems and dementia symptoms. Forgetting your keys or walking into a room and forgetting what you went in there for are normal memory lapses. But if memory lapses are starting to affect everyday life and are getting worse, they may be a sign of dementia.
Depression In Older Adults
Depression is a mental health issue that causes a person to feel continued sadness. They can lose interest in everyday things. Depression is one of the most treatable mental health disorders. Seeking help can significantly improve an individuals life.
Some depression signs and symptoms are:
- Trouble concentrating,
- Suicidal thoughts
If it is depression, getting treatment can improve memory, concentration and the energy. Making some lifestyle changes can also have a positive impact. Eating healthy, getting enough sleep, staying active, being socially engaged, exercise and controlling stress levels are all important to ones emotional health.
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Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
Stage : Age Associated Memory Impairment
This stage features occasional lapses of memory most frequently seen in:
- Forgetting where one has placed an object
- Forgetting names that were once very familiar
Oftentimes, this mild decline in memory is merely normal age-related cognitive decline, but it can also be one of the earliest signs of degenerative dementia. At this stage, signs are still virtually undetectable through clinical testing. Concern for early onset of dementia should arise with respect to other symptoms.
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Managing Memory Changes In Dementia
A number of practical suggestions that can help carers to manage memory loss in people with dementia include:
- avoiding stressful situations providing emotional support, reducing background noise and distractions, and exercise can all help to reduce stress and improve memory
- maintaining a regular routine keeping to a routine can help with a sense of security and reduce confusion
- trying memory aids using memory aids like lists, diaries and clear written instructions, can help if the person with dementia is happy to use them.
When Depression Is Really Dementia
Depression and dementia are so closely related that even close family members may have difficulty sorting out the signs of both conditions. When a diagnosis cant be positively made, doctors tend to treat obvious signs of depression while encouraging careful observation to spot signs that may indicate the presence of a dementia-related condition. Possible indications that depression is really dementia may include:
- Not being able to remember names, facts, or recent conversations even when prompted
- Being unable to correctly determine time and place
- Attempting to cover up forgetfulness
If your loved one has a dementia-related condition, it wont be unusual for him or her to realize something is happening during moments of clarity, which may result in depression. Due to the difficulties associated with making an accurate diagnosis, treatments can vary greatly. However, its worth noting that some forms of dementia can be successfully reversed with medications that boost chemical messengers within the brain to enhance memory and judgment.
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Path To Improved Health
From the outside looking in, it may be difficult to know if your family member is depressed. You can look for some of the typical signs of depression. Your loved one may become angry and agitated or lost and confused. They may refuse help with personal care, such as getting dressed or taking medicines.
Alzheimer dementia and depression have many symptoms that are alike. It can be hard to tell the difference between them. If you think that depression is a problem for your loved one who has Alzheimer dementia, talk to their doctor.
Why Dementia Can Be Difficult To Spot
There are several reasons why dementia can be difficult to spot.
There are many different signs and symptoms of dementia and quite a few of them are non-specific. That means theyre general symptoms such as disturbed sleep, forgetfulness and low mood. Many of these are found in conditions other than dementia. Symptoms also appear slowly and develop gradually, making them difficult to spot.
A doctor wont be able to diagnose dementia based on one specific symptom. They do several tests to find out if someones symptoms are caused by dementia or something else. Tests include:
- a physical examination
- questions about general health and symptoms and how these have changed over time
- blood and urine tests to rule out other conditions and causes
- cognitive assessments these tests look at mental abilities, including memory and language
As we get older, its common to become a little forgetful especially if were stressed or have been ill. Although dementia is closely linked to age, its different from this normal age-related memory loss.
In older age, were also more likely to develop other conditions that can easily be mistaken for dementia. These include conditions such as depression and delirium. If someone with dementia develops another condition, that can sometimes be missed if the symptoms are similar.
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Supporting Someone With Dementia Who Has Mental Health Problems
Its common for people with dementia to experience depression, anxiety or apathy . Alzheimers UK has information about how these problems might affect someone with dementia and ways to support them and get them the right support and treatment.
Improving the mental health of someone with dementia can improve their overall quality of life, for example, by helping them engage with friends and relatives, improving their appetite and sleep quality, and boosting their motivation.
References:
Depression As A Risk Factor
It is well established that depression is a risk factor for dementia, but speculation still exists that the cognitive dysfunction occurring with depression leads to the decline and impairment recognized as dementia. More research has been done to establish what type of depression predicts the development of dementia results show that early-onset or late-onset , are the most likely to lead to dementia later in life.
A study done in Nature Review Neurology affirmed the correlation between depressive symptoms early in life, and the magnified increase in dementia risk.
For older people already suffering from dementia, depression may manifest itself as physical symptoms, rather than its commonly known cognitive symptoms. These symptoms can include a loss of appetite or energy. This does not discount the many cognitive symptoms that can appear as a result of depression the Alzheimer’s Society provides a comprehensive list of these symptoms on their website.
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Is Depression The First Sign
Researchers and clinicians have been thinking for a long time about the relationship between depression and dementia. Sometimes, depressive symptoms are the first glimpse of the brain failure that will lead to dementia. Some researchers believe that depression increases inflammation and other chemical changes in the body, actually increasing the risk of later dementia. Everyone agrees that depression and dementia together create more suffering and complications than either condition alone.
Recognizing Depression Or Normal Memory Loss Vs Dementia And How To Tell The Difference
May 23, 2017
As we age, we sometimes get a little more forgetful.
As we age, we sometimes get a little more forgetful. While most people understand that this is just a normal part of getting older, there are some who fear that forgetfulness is the first sign of Alzheimers disease or some other form of dementia. There has been a lot of research focused around aging and memory loss recently, and researchers have learned a lot about what is normal versus a more serious problem.
Aging is not the only factor that contributes to memory loss, however. Many older adults develop memory problems as a result of health issues that may be treatable. These can include: side effects due to medications, vitamin deficiencies, substance abuse or possibly even reduced organ function due to thyroid, kidney or living disorders. These can be serious medical conditions and should be treated as soon as possible.
In addition to the aforementioned medical issues which can precipitate memory loss or impairment, there is what seems to be the most common reason: depression. Depression in older adults has been as steadily growing problem, and emotional problems such as stress, anxiety or depression can and quite often do lead to forgetfulness, confusion and other symptoms that are similar to those of dementia.
What is Dementia?
How to Tell the Difference
Alzheimers Association
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Why Is Depression Often Mistaken For Dementia
by michael | Nov 17, 2020 | Alzheimers and Dementia |
When it comes to taking care of their aging loved ones, families are often careful to take notice of changes to the persons personality, mood, and behaviour. Oftentimes, two conditions come to mind when these distinct changes take place: depression or dementia.
There are many symptoms these illnesses share, which is why it can be difficult to differentiate between the two. Generally, the distinction can be made by understanding what is generally behind both conditions:
- Dementia: A chronic, progressive disease caused by brain disease or injury that presents itself through impaired memory, personality change, and decreased reasoning
- Depression: A mental health disorder that affects behaviour, thinking, and disposition
- Delirium: Often caused by being put into a new place, dehydration, or medication
Another important distinction between the two is that depression is considered a mental health issue, while dementia, although it can affect overall mental well-being, is not.
A third condition that is sometimes confused with depression or dementia is delirium. Delirium is a short-term memory loss that results from a person being put into new, unfamiliar surroundings or living conditions, becoming dehydrated, or having a reaction to medication. This condition is often reversible if treated early, whereas most types of depression and dementia can be treated but arent reversible.
What are the symptoms of dementia in seniors?
Lack Of Vitamin B12 And Lack Of Thiamine
Vitamin B12 is found in meat, fish, eggs and cheese. Thiamine is also a B vitamin and is found in whole-grain foods, some breakfast cereals, beans and peas, nuts and seeds.
Both are important for a healthy nervous system. If someone doesnt get enough of either of these vitamins, they can have symptoms that could be mistaken for dementia. These include confusion, memory loss, irritability and a change in mental state.
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Memory Loss And Dementia
There is a difference between memory loss as a normal part of ageing and the memory changes seen as a symptom of dementia. Normal forgetfulness may include misplacing the car keys or walking into the kitchen and forgetting why you went there. The person with dementia may lose the car keys and then forget what they are used for.
Memory loss in a person with dementia is persistent and progressive , not just occasional. It may affect a persons ability to continue to work or carry out familiar tasks. It may mean having difficulty finding the way home. Eventually, it may mean forgetting how to dress or how to bathe.
The loss of memory can progress and affect memory of:
- events the person may forget part or all of an event
- words or names the person progressively forgets words and names of people and things
- stories on TV, in movies or books the person progressively loses the ability to follow stories
- stored knowledge over time, the person loses known information such as historical or political information
- everyday skills the person progressively loses the capacity to perform tasks such as dressing and cooking.
Depression Mixed With Dementia
Regarding depression as a prodromal state of dementia, Ownby et al. conducted a meta-analysis of 9 case-control and 11 cohort studies and reported odds ratios of 2.03 and 1.90 for the development of AD in patients with a history of depression compared with those without a history of depression, respectively . Other meta-analyses have reported odds ratios of 1.65 and 2.52 for the development of AD and VaD, respectively, in older patients with a history of depression compared with patients without a history of depression . In addition, a systematic review of longitudinal studies of pseudodementia reported that 33% of patients with depressive pseudodementia had progressed to irreversible dementia at follow-up . Recently, depression has received special attention as one of the precursors of DLB, and a retrospective study of 90 patients with DLB reported that depressive symptoms preceded memory impairment by an average of 4.8 years .
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What Is Alzheimer Dementia
Alzheimer dementia is the most common type of dementia. Dementia is a group of symptoms caused by damage to brain cells. This can happen because of a tumor, head injury, stroke or disease. Alzheimer dementia makes it hard for people to remember, learn, and communicate. These changes eventually make it hard for people to care for themselves. It may also cause changes in mood and personality.
Depression is very common among people who have Alzheimer dementia. In many cases, they become depressed when they realize that their memory and ability to function are getting worse. Together, depression and Alzheimer dementia can cause other symptoms. They may not want to go places or see people anymore. Their outlook and quality of life can suffer.