Fundamentals - Gerontology, part 10: The 3 D's

Hi, I'm Ellis. And in this video, I'll be covering the three Ds, which are dementia, delirium, and depression. This card can be found in the gerontology section of the fundamentals card deck. So if you have that deck, grab this card and follow along. It can be really helpful because there's some red bold text, and it's [inaudible] nice little table for you. So this card covers the differences between dementia, delirium, and depression related to its onset, its acuity, its length, its cause, whether it changes the level of consciousness, and any behavioral changes. So we're going to start with dementia. Dementia is a gradual progressive onset. It is chronic, and it's non-reversible. It is usually caused by a neurodegenerative disease like Alzheimer's. Dementia does not change somebody's level of consciousness, meaning it will not impair their ability to remain awake, right? It doesn't make them excessively sleepy or hard to wake up, and their behavior is fairly normal until it gets into the more advanced stages. Delirium has an acute and sudden onset, but it's transient and reversible. And that's because it's caused by metabolic imbalances, metabolic disorders, infections, and toxins. So if we can address the underlying cause that is making our patient experience delirium, then we can get rid of the delirium. It does sometimes change a patient's level of consciousness, meaning it has an impact on their ability to be awake, remain awake, and it can affect their behavior. It can cause them to be easily distracted. It does impact sleep, wake balances, and it can result in hallucinations.

Depression is characterized by mood changes that last for more than two weeks. It is treatable, usually with psychotherapy and/or pharmacotherapy or medications. Its cause is usually a neurotransmitter alteration, but it is definitely compounded by psychosocial factors. Depression generally does not have an impact on level of consciousness. So it doesn't impact somebody's ability to be awake, but it does usually impact behavioral changes, so it can make somebody feel more anxious and cause anxiety. It can also create somatic changes which include lethargy, pain, and insomnia. The reason that this card exists is because these three disorders, they kind of overlap a little bit, and unfortunately, they are often misdiagnosed as each other. So a patient might be experiencing delirium, but somebody might chalk it up to, I don't know, dementia. And they just think it's dementia and that that's just a thing that happens, and that it's non-reversible, so there's nothing we can do about it. But they could just be experience a infection, and if we address the infection, then the delirium would cease and their behavior would return to normal.

So it's just really important to consider that while they have similarities, they do have very clear differences, and those need to be considered when we are working with practitioners and reporting behavior and other assessment data to help differentiate between the three. Of the three Ds, which has a sudden and acute onset? Delirium has a sudden and acute onset. Dementia's onset is more gradual and progressive, and depression is a mood change that lasts at least over two weeks. What are the potential causes of delirium? Likely causes of delirium are metabolic imbalances, infections, and toxins. Describe the behavioral changes that may be present in a patient with dementia. Patients experiencing dementia are unlikely to have significant behavioral changes unless the disease is in an advanced stage. Patients experiencing delirium or depression are more likely to have behavior-related changes.