I recently attended a luncheon for professionals in the caregiving industry. Henry Williams, MD, a gerontologist with the Overlake Senior Care program spoke to the group about the “Differentiation of Dementia, Depresssion and Delirium.”
I was fascinated by his straightforward presentation and took notes the best I could. Here is a summary of some of his major points about each condition.
Dementia is Abnormal Aging
Dr. Williams described dementia as acquired, progressive and involving the loss of memory and executive functioning such as scheduling. Other characteristics of dementia include difficulty recognizing familiar objects, difficulty with speech and reading and using everyday tools such as the phone or microwave.
He noted that only 1-2 percent of 60-year-olds have dementia but about 50 percent of those 85 have it with about 60 to 70 percent of all dementia is the Alzheimers type. He said the risk factors for dementia are age, trauma like a blow to the head and genes. Dr. Williams added that medications can also affect dementia or delirium. He listed drugs he considered dangerous for contributing to dementia: anticholinergic, benzodiazepenes, cimetidine, Darvon, Demerol, muscle relaxant and NSAID
“You don’t get dementia unless you inflame the veins or brain with conditions such as stroke, high cholesterol or systolic hypertension,” said Drl Williams. “The best anti-inflammatory or prevention is 30-minutes exercise a day, be aware of hypertension and other risk factors and keep hydrated.”
Depression Can Look Like Dementia
Dr. Williams said depression is similar in presentation to dementia but it is usually recent onset, patients are usually withdrawn, hve sleep disturbances, gain weight, lose weight and may have mixed cognitive deficits as well as mood disorders.
Treatment such as cognitive behavior counseling therapy works about 50 percent of the time. Whereas, a combination of counseling and drugs works about 80 percent of the time. Drugs that are related to depression include betablockers (anti-arrhythmics, alcohol, tranquilizers, OTC-kava and muscle relaxants.
“Most seniors have anxiety,” observed Williams. “But depression usually results in isolation and mood is of recent onset. In contrast, those with dementia still have long-term memories present.”
Delirium Confuses the Sense of Reality
Most individuals with delirium act docile and retarded, said Dr. Williams, about 20 percent present as very hyperactive. Statistically, about 20 percent of patients with delirium are going to die, 20-30 percent return to normal and about half will suffer behavioral, and cognitive deficits that last a long time. “Delirium is a huge medical emergency for seniors because it is often unrecognized,” he explained. “But it is preventable and treatable.”
People with delirium present changes in language and memory perception, lack of consciousness of the environment and inattention. “We see acute fluctuations in mental behavior including the “fight or flight” instinct.
Why do people get delirium? It’s a loss of acetylcholine, said Dr. Williams and the risk factors include low oxygen in the blood sugar and low blood pressure. It can relate to dementia, infection, metabolic issues, medications, anticholinergic, nutritional state and narcotics as well as disease and dehydration.
I looked “acetylcholine” (ACh) up. I found it is a neurotransmitter and that in the central nervous system it plays a role in attention and arousal.
He noted that about 50 percent of people with dementia get delirious. The significance of the diagnosis is that it contributes to high hospital stays, high mortality and 20 to 30 percent who never return to normal functioning.
Dr. Williams summarized his presentation this way, “Change in cognition is not normal and may signify delirium. Always question diagnoses because all three problems can occur by themselves or together. All are treatable and delirium is preventable.”
More about Delirium
I was intrigued by Dr. Williams’ presentation and wanted to learn more about delirium. Here is some information I found on the Harvard Medical website:
Delirium is a sudden change in mental status characterized by confusion, disorientation, altered states of consciousness (from hyperalert to unrousable), an inability to focus, and sometimes hallucinations. It’s the most common complication of hospitalization among older people.
Hospital delirium is especially common among older people who’ve had surgeries such as hip replacement or heart surgery, or those who are in intensive care. Anything that interferes with neurotransmitters—the brain chemicals that communicate between nerve cells—can trigger it, including inflammation, infection, and medications. Also implicated are a host of potentially disorienting changes common to hospital stays, including sleep interruptions, unfamiliar surroundings, disruption of usual routines, separation from family and pets, and being without eyeglasses or dentures.
As described in the Harvard Women’s Health Watch,family members and close friends can do a lot to help prevent or limit delirium in an older person:
- Make sure that hospital personnel have a complete list of all the medications the person is taking, including over-the-counter medicines.
- Make things familiar for the person. Take a few family photos or other favorite things (such as a blanket, rosary, book or music tape) to the hospital.
- If someone develops hospital delirium, stay with him or her in the hospital as much as possible, including at night. In addition to providing comfort and reassurance, family members are more likely than others to recognize when their loved one isn’t behaving normally or being treated appropriately.
- Make sure the person has his or her eyeglasses, hearing aids, or dentures. These are often put away during a hospital stay, but that can contribute to disorientation.
- Promote physical and mental activity. Help the patient get up and walk two or three times a day. Engage in quiet conversation about current events or family activities. Play card games or do crossword puzzles together.
What is your experience with dementia, depression and/or delirium?