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Why Is Depression Often Mistaken For 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?
Here are some of the signs to watch out for:
How Is Delirium Diagnosed
Healthcare providers look for problems with attention, memory, orientation and visual ability. Providers may ask the person to perform a few simple tasks, such as spelling a short word backward or doing a basic math problem.
A provider may diagnose delirium if the person:
- Cant focus or shift attention.
- Has changes in thinking.
- Has a rapid onset of thinking problems, which may change throughout the day.
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How Will The Provider Decide What Treatment Is Best
Other medical conditions usually cause delirium. Its important to treat those conditions to treat the delirium. The provider will review the persons:
- Medical history.
- Lab results.
- Drug use, including over-the-counter drugs, illicit drugs and alcohol.
The person may not be able to answer questions about themselves. So providers may ask the persons family member or loved one:
- Did the confusion begin suddenly or gradually?
- How quickly did it progress?
- What was the persons mental and physical state before this?
- Is the person taking any drugs or dietary supplements?
- Did the person stop or start any new medicines or drugs recently?
Dementia & Alzheimer’s Disease
There is a pertinent question that everyone especially the elderly should know the answer to and that is: what conditions can be mistaken for dementia?
However, when they go to the doctors for a diagnosis, it turns out that they do not have dementia, but another medical condition.
This is the primary reason why it is important to avoid self-diagnosis and always consult a doctor when you have dementia warning signs.
At times, a person may even have to seek a second and a third opinion.
Unfortunately, sometimes, it is the doctor who will give a misdiagnosis based on the symptoms that a person has.
There is a long list of curable or partially reversible medical conditions that share symptoms with dementia.
Here are some of the most common ones.
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Deliriumaka Acute Confusional Stateis A Medical Emergency Marked By A Fluctuating Mental State Confusion Altered Consciousness And Unusual Behavior
Delirium shouldn’t be confused with dementia, though it can happen, as there are overlapping symptoms.
Delirium is a medical syndromenot a diseasein which there is a rapid onset of confusion, altered consciousness, and behavioral changes. Unlike dementia, which shares some of these symptoms, the onset of delirium is usually within hours or days .
Delirium is considered a medical emergency. Sufferers should seek medical advice immediately, so that accurate diagnosis and prompt treatment can be initiated. Its usually reversible, but if not treated correctly, it can lead to long-term disability and even death. The mortality rate is estimated to be 10 to 26 percent, or even higher if it develops in patients who are already critically ill.
Going For An Assessment
The lists of conditions and problems above are not exhaustive. Theres a whole range of things that can occasionally cause dementia-like symptoms for some people, and its not possible to go into them all here.
There is not always a quick answer to the question ‘Is it dementia or something else?’ But the most important thing is that if someone has dementia-like symptoms, they should see their GP for a full assessment, to work out what the problem is.
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Acute Onset/fluctuating Levels Of Consciousness
Delirium is characterized by an acute change in mental status. Patients demonstrate fluctuating levels of consciousness that they often manifest by periodically falling asleep during an interview. This fluctuation in consciousness can result in conflicting reports from various caregivers about the patients mental state. Fluctuations in cognitive skills, including memory, language, and organization, are also common.
What Is The Outlook For People With Delirium
Patients can recover completely if the cause of delirium is identified quickly and addressed. Any delay makes it less likely theyll recover quickly and/or fully. Lack of treatment can lead to stupor, coma or even death. Older persons with dementia and those with HIV are less likely to have a complete recovery.
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Identifying Underlying Medical Conditions
The definitive treatment for delirium is to correct the underlying medical condition causing the disorder. The initial steps in managing patients with delirium are to conduct a careful review of the medical history, physical examination findings, laboratory evaluations, and any drugs the patient is using, including over-the-counter agents, illicit drugs, and alcohol. Information from patients current and past medical history, as well as the physical examination, should guide the initial work-up. Often the etiology will be fairly obvious from the history and basic laboratory tests.13 Table 66,14 outlines a plan for assessing patients with delirium.
The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.
Medical Conditions That Can Mimic Dementia
James M. Ellison, MD, MPH
Swank Center for Memory Care and Geriatric Consultation, ChristianaCare
- Expert Advice
Learn about medical disorders that can interfere with cognition and mimic dementia.
Even as a sleep-deprived and inexperienced intern, several decades ago, I knew something was wrong when I was asked to evaluate Mrs. M, a woman well into her 90s who was admitted for care of dementia. She was reputed to have been sharp as a tack until the preceding week. Following the operation that repaired her cataracts, which in those days meant a period of patched eyes and bedrest, her behavior changed quickly and dramatically. Her lovely personality became irritable and angry. Her language became abusive. She scratched a caregiver in her nursing home who was trying to help her get dressed.
It seemed very likely to me that Mrs. Ms sudden change in behavior had more to do with her operation than with a progressive neurological condition.
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Can Delirium Be Prevented
Before you or a loved one has surgery, talk to your healthcare provider about assessing your mental status before the procedure. This way, your provider can establish a baseline. If your mental status changes after surgery, providers have presurgical measurements for comparison. And if you or your loved one has risk factors that increase your chances of developing delirium, talk to your provider.
These other tips can help prevent delirium:
- Keep a clock and calendar nearby.
- Have plenty of lighting during the day.
- Talk to your healthcare provider about limiting medicines that arent needed, especially those that may cause delirium.
- Drink plenty of water and other fluids.
- Take a walk every day, or at least get out of bed and sit in a chair.
- Talk to your healthcare provider if you have any signs of an infection, such as cough, fever, pain or shortness of breath.
- Keep your family involved in the treatment plan.
A Condition That Can Fool Even Experienced Doctors
In fact, Mrs. M was suffering from delirium, at that time called acute organic brain syndrome that results in rapidly changing mental states, and causes confusion and changes in behavior. She returned to her previous healthy cognitive status very quickly after her eye patches were removed and her post-operative recovery continued.
The lesson I learned from her recovery was that delirium can fool even experienced doctors into misdiagnosing dementia, which is now called Major Neurocognitive Disorder . Confustion, disorientation, and memory impairment are signs of delirium that are shared with MaND.
Delirium looks very different, though, in other ways. It comes on rapidly, often after a medical or surgical event or toxic combination of medications. It is accompanied by shifting alertness, resulting in moments of sleepiness alternating with moments of agitation. Delirium is more often associated with visual hallucinations or psychotic delusions than MaND. And, most importantly, delirium can often be reversed once the cause is found and treated.
Its causes are many and include infection, metabolic disturbances, toxic medication reactions, withdrawal from alcohol, and the effects of head injury, just to name a few.
What makes this especially tragic is that distinguishing delirium from MaND is usually not too difficult and just requires careful attention to history, symptoms, physical and mental status examinations, and the results of common laboratory tests.
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The Difference Between Delirium And Dementia
Dementia and delirium are both health conditions that change a persons ability to think clearly and care for themselves. They do share some similar symptoms. But they have different causes, treatment, and outcomes.
Delirium is seen as a medical emergency that needs to be treated right away. But it can often be mistaken for dementia. In some cases, these conditions can occur at the same time. Learn how they are different, and what you can do to help a person who has signs of either or both.
Indications Of Underlying Medical Conditions
Recognizing delirium is important because it is an indication of an underlying medical condition that should be identified and treated. The underlying etiology should be aggressively sought after. Delirium can be caused by a medical emergency or a subacute, chronic medical condition .6 Prescription drugs, illicit drugs, and toxic substances can also cause delirium. The underlying medical condition is not always readily identifiable, and more than one etiology is often responsible for delirium. In fact, in almost one half of elderly patients with delirium, two or more underlying conditions are responsible for the delirium.7
The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.
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Risk Factors For Developing Delirium
Risk factors can fall into one of two categories: predisposing and precipitant factors. Predisposing factors include being over 70 years, dementia, functional disabilities, poor vision, poor hearing, mild cognitive impairment, and alcohol abuse.
Precipitating factors include medication, drugs, surgery, anesthesia, high pain levels, anemia, infections, acute illness, and acute exacerbation of chronic illness.
One systematic review found that 10 to 31 percent of new hospital admissions met criteria for delirium, and between 3 and 29 percent of people admitted to a hospital went on to develop delirium during admission.
The rate of developing delirium was around 80 percent for those in intensive care units. In the post-operative period, it developed in 5 to 10 percent of people following general surgery and 42 percent following orthopedic surgery.
As people near death, around 80 percent will develop delirium. The risk of delirium increases with age, and its very common in nursing home residents.
Dementia is one of the strongest risk factors, being present in 25 to 50 percent of people with delirium.
What Are The Symptoms Of Delirium
A person with delirium may be confused and have problems with memory, They may be agitated or drowsy.
Signs of delirium include:
- having problems with memory, particularly of recent events
- being disoriented, not knowing where they are, who they are or what time it is
- problems with perception
- having hallucinations or delusions
- alternatively, being quiet, drowsy and lethargic
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Does Delirium Require Hospitalization
In some cases, the person is in the hospital when they develop delirium. If they are not, they will most likely need hospitalization. In a hospital setting, providers can monitor them and keep them from injuring themselves or others.
Providers try to identify the cause of delirium quickly to get the patient treatment as fast as possible. Once providers identify and treat the reason, they can often reverse the delirium.
A team of multiple providers can help give the best care. Its important to prevent related problems such as undernutrition and incontinence. A care team may include a:
- Physician, nurse practitioner and/or physicians assistant.
- Physical therapist.
- Quetiapine .
Lung And Heart Disorders
Disorders of the heart and lungs are some of the top answers available for anyone who asks what conditions can be mistaken for dementia.
This is mainly because the two organs provide nutrients and oxygen to the brain hence, they are essential for normal functioning.
As people age, they may develop vascular diseases that interrupt cardiac output. Others can get lung diseases that affect oxygen delivery to the brain.
When this happens the affected person may have issues with executive function, memory, and alertness which can fool people into thinking that it is dementia.
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How Can I Care For Someone With Delirium
Often, treatments for delirium focus on the environment. Its best if the person is in a quiet setting. If you are caring for someone with delirium, try these tips:
- Promote good sleep habits: During the day, keep them awake, and expose them to sunlight. Avoid naps. Help them sleep at night by reducing noise and distraction.
- Provide reassurance: Help them understand their environment. Explain what is happening.
- Bring familiar objects: Surround them with items from home, such as photos, a blanket or a bedside clock. These things will help the person feel more comfortable in the environment. Try soothing music as well.
- Encourage eating: Make sure the person eats and drinks nutritious food throughout the day, if appropriate.
- Encourage movement: If its safe, help the person get out of bed and move around.
- Help orient them: Talk about current events and family news to provide mental stimulation. Reading out loud can be helpful as well.
Delirium In People With Dementia
Distinguishing between delirium or dementia is important however, a more difficult task may be identifying delirium in someone who already has dementia. According to a study by Fick and Flanagan, approximately 22% of older adults in the community with dementia develop delirium. However, that rate skyrockets to 89% for those who have dementia and are hospitalized.
Knowing how to identify delirium in someone who is already confused is critical for appropriate treatment and a faster recovery. Delirium superimposed on someone with dementia also is connected with a more than double mortality risk compared to those with delirium or dementia alone.
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Differentiating Dementia Delirium And Depression
13 April, 2015By NT Contributor
How can you tell the difference between dementia, delirium and depression in older people, to ensure they receive the right care? Current knowledge on this question is summarised in this article, and is also available as a learning resource in our learning unit on dementia, delirium and depression
Citation: Polson J et al Differentiating dementia, delirium and depression. Nursing Times 111: 16, 19.
Jilly Polson and Suzanne Croy are dementia lead associates, Dementia Services Development Centre, University of Stirling.
- Scroll down to read the article or
Differentiating Among Depression Delirium And Dementia In Elderly Patients
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.
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