1 The Three D’s an overview SESSION 9. 2 Objectives To review the definitions of Dementia, Depression, and Delirium. To understand in what ways these.

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The Three D’san overview

SESSION 9

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Objectives

To review the definitions of Dementia, Depression, and Delirium.

To understand in what ways these cognitive disorders are similar

To understand which features help define or distinguish one from the other.

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Definitions

DEMENTIA DEPRESSION

DELIRIUM

cognitive decline due to brain disease.

acute change in mental status

change in mood with feelings of worthlessness.

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Common Presentation

DEMENTIADEPRESSION

DELIRIUM

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Case A

75F widowed 1 year ago, now living with her son, increasingly more forgetful, increasingly dependent with IADLs, losing weight and getting weaker over the past year, sustained a fall and hip fracture 2 weeks ago, but now not eating well, sleeps all day, restless at night, and not participating well in rehabilitation efforts.

The son is upset about this and wants to know why she is not improving and what you are doing about it.

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Distinguishing Features

Distinguishing Feature

Associated Symptoms

TimeCourse

Delirium

Dementia

Depression

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Case A

75F widowed 1 year ago, now living with her son, increasingly more forgetful, increasingly dependent with IADLs, losing weight and getting weaker over the past year, sustained a fall and hip fracture 2 weeks ago, but now not eating well, sleeps all day, restless at night, and not participating well in rehabilitation efforts.

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DELIRIUM: The Acute History

The son says… Mother confusing him

for her deceased husband

Picks in the air Falls asleep while he’s

trying to talk to her New behavior since

the surgery

The nurse says… Restless at night Placed in hallway by

nurses station because trying to climb out of bed

Pulled out foley and IV once already

Only new med is Acetaminophen

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DEMENTIA: a Chronic and Progressive History The son says…

More forgetful during past year, but not THIS bad!

Previously independent in all ADLsDependent in Shopping, Transportation,

Finances (husband used to do this before)Cooks basic meals (less frequent, less fancy)Complains of fatigue, naps a lot, TV, dosen’t

leave house anymore.

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DEPRESSION: episodic, recurrent The son says…

History of depression in past, on antidepresants intermittently in her lifetime.

On Zoloft 75mg since death of her husband one year ago.

Longtime insomnia, takes ativan 2 mg qhs prn (average 3x per week), awakens 4am

Appetite fair in past year No longer reads books Feelings of despair, thoughts of dying, no suicidal GDS score 7/15

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PMHHTNDepression InsomniaB Knee Arthritis

MEDICATIONSLisinopril 10 mg qdZoloft 75 mg qdAtivan 2 mg qhs prnTylenol 650 mg q4h prn

painCelebrex 100 mg po qd Percocet one tablet po

q4h prn severe pain

NEW

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Physical Exam

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Mini-mental Status Exam Orientation: 2/5 Date: 0/5 Registration: 1/3 Attention: serial

sevens 0/5, WORLD backwards 2/5

Naming: 2/2 Short-term memory:

0/3 3-step command: 1/3 Read and Obey: 1/1 Sentence: 1/1 Visualspatial: 0/1

SCORE=10/30

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Clock-Drawing Task

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Assessment and Plan

DX:DeliriumDepressionmaybe Dementia

PLAN:NonpharmacologicPharmacologic