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The Many Faces of Dementia: Delirium and depression

Editors note: This is the final of a four-part series of articles designed for those who want a better and more in-depth understanding of Alzheimer’s disease. It is reprinted with permission from the Alzheimer’s Foundation of America. For information, go to http://alzfdn.org, or call its 24-hour helpline at 866-AFA-8484.

Delirium



Co-existing conditions such as delirium can, in premature diagnosis, be mistaken for a dementia. There are a number of key symptoms that differentiate delirium from dementia but delirium can also be present with a diagnosed dementia.

• Delirium is defined as a temporary confusion caused by underlying medical problems, drug toxicity or environmental factors.




• Delirium is a very common yet often-unrecognized condition in elderly individuals with dementia.

• It is marked by confusion and disorientation; fluctuating levels of consciousness; jerking motions; disruption of sleep-wake cycles; hallucinations, delusions and anxiety; memory impairment and altered speech; intermittent agitated behavior; mood changes; behavioral problems, such as aggression and wandering; and changes in blood pressure and pulse.

• Delirium follows a time pattern. It has an abrupt onset — less than one month — and a short duration — not more than one month from the time the symptoms are detected to intervention and recovery.

• Medications are often the major cause of delirium in the elderly. This results from drug interactions, failure to take medication, slow absorption of medications, characteristics of the drug itself or the use of anesthesia and other medication during and after surgery.

• Underlying medical problems that may cause delirium are bladder infection, pneumonia, dehydration, metabolic disorders, oxygen deficiency, constipation and urinary retention.

• Environmental factors may also contribute to delirium. This ranges from sensory overload, such as too much noise, to sensory deprivation stemming from isolation, hearing impairment and lack of environmental stimulation.

• It is important to identify the risk factors for delirium and learn about preventative measures. For example, providing adequate hydration and carefully managing medication are preventative approaches.

• Delirium does not involve structural brain damage.

• Individuals may completely improve from delirium if the medical problem is identified and treated.

• If delirium is left untreated, individuals develop additional complications that may result in poor outcome or death.

Depression

• Individuals diagnosed with dementia can be present with coexisting depression.

• Several symptoms are common to both dementia and depression: apathy, lack of interest in people or activities, poor sleep, restlessness, memory loss and difficulty concentrating.

• Distinguishing between dementia and depression and determining whether each condition exists or if they co-exist is critical to ensure proper treatment.

• The frequency and severity of depression remain fairly constant through most stages of Alzheimer’s disease.

• For most individuals with Alzheimer’s disease who develop depression, it tends to be mild and moderate in severity, and suicidal behavior or completed suicide is rare.

• Depression may cause or worsen memory loss and other cognitive impairment.

• It appears that Alzheimer’s disease is more likely to develop in people who have depression plus cognitive impairment but that depression occurring without cognitive impairment does not increase the risk of developing the disease.

• Counseling or psychotherapy may be helpful in mild to moderate depression in the earliest stages of dementia, but systematic studies on this issue are lacking.

• Antidepressants are usually indicated for those with Alzheimer’s disease who demonstrate persistent or severe depression. However, only half of the published research shows superiority for antidepressant medication over placebo in the treatment of depression in those with Alzheimer’s disease or dementia in general.

• If a physician prescribes antidepressant medications, it is important to monitor the choice of medication, dosage, possible side effects, impact on cognition and activities of daily living and the status of the depression.

Tor Eckert has been involved with Alzheimer’s disease and other dementias for nearly eight years, including owning an Alzheimer’s care Home. He was designated as a “health care professional” by the AFA in 2008. He has pro-bono public forums and programs – The Many Faces of Dementia. For information, please contact him at torecket@sbcglobal.net


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