Three Ds Caregivers Need to Know: Dementia, Depression, and Delirium

When I worked as a mental health consultant in nursing homes, the most common call I received went something like this:

“Carrie, Mildred’s really acting up this week. Do you think you could get the doctor to increase her Alzheimer’s meds?”

My response was always the same: “Did you check for a urinary tract infection?” In most cases, the nursing home had not. I refused to evaluate the resident or contact the doctor until a urinalysis was completed.

Why? Because urinary tract infections (UTIs) are evil, particularly when they affect older adults. Not only are they painful – they can also cause confusion, agitation, and even delusions and hallucinations. Unfortunately, when a person with dementia has a UTI, the symptoms that ensue are often attributed to the dementia instead of the infection. This is a precarious assumption to make because it can result in the UTI not being treated and the person becoming sicker and more impaired.

In essence, UTIs – along with other infections, dehydration, malnutrition, medication interactions, and other acute medical problems – can cause delirium, an acute state of severe confusion and behavior change. While the word “delirious” is common and casually associated with happy, giddy states, delirium is nothing to laugh about. In fact, if delirium is not treated immediately, it can have serious, if not fatal, consequences.

© Loretta Humble
© Loretta Humble

Depression is another condition that displays symptoms often confused with dementia. Older adults experience depression a bit differently than younger adults in that they complain more about memory problems and apathy and less about sadness and depressed mood. The tragedy entwined with these similarities is that families sometimes assume their older relative has dementia when he or she is actually depressed.  This assumption often delays a trip to the doctor that could have resulted in successful treatment of the depression.

The reality is that a loved one should be taken to the doctor whether the family believes the culprit is delirium, depression, or dementia. While dementia is the most chronic, irreversible condition, it’s still vital to find out what kind of dementia it is. Think of dementia as an “umbrella” term under which many diseases fall. Alzheimer’s disease, stroke, Lewy body disease, normal pressure hydrocephalus, and several other illnesses can cause dementia – a progressive, degenerative disease of the brain that results in changes in thinking, memory, judgment, behavior, and daily functioning. Doctors are pretty good at determining what kind of dementia is occurring, which leads to better management of the disease.

If I’m overwhelming you with medical nomenclature, please rest easy. Caregivers do not need to know how to differentiate between the three Ds. But you do need to know that these three Ds exist, that they are common among older people, and that it’s imperative to determine which, if any, of the three Ds your loved one is facing if he or she begins having difficulties. Here are a few things to remember:

  • Delirium often comes on quickly. If you notice a sudden, drastic change in thinking or behavior, contact your doctor immediately.
  • Depressed people usually have the ability to function at their previous level, but they don’t have the motivation to do so. On the other hand, those with dementia have often lost the ability to function as they once did.
  • Delirium and depression can often be reversed if promptly diagnosed and treated.
  • Delirium, depression, and dementia may occur in combination.

If you’ve already had experience with the three Ds, please share your insights here. Dealing with the three Ds can be scary and confusing for caregivers, so your wisdom can help others cope and make informed choices about their loved ones’ care.


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