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"What if I see you, and I don't know that
  you're my daughter, and I don't know that
  you love me?"

"Then, I'll tell you that I do, and you'll
  believe me.”

    - Lisa Genova, Still Alice -

It’s not always Alzheimer’s …

Has Aunt Sophia suddenly been acting irritable and scared without reason? Has Uncle Luis abruptly passed from being forgetful to being confused, sometimes making sense, but not always?

All too often when an older adult is acting differently, has memory loss and confusion, mood changes, or sees things that aren’t there, we jump to the conclusion he is simply getting older. Perhaps we conclude he has dementia or Alzheimer’s disease and there is not much we can do about it.

But we could be wrong. Symptoms can be confusing and memory loss is not always an indicator of dementia or Alzheimer’s. Delirium and depression can have similar symptoms. Since both depression and delirium can be cured and the treatments for all three differ, it’s important to see a doctor for an accurate diagnosis and effective treatment.

The following are clues to the differences between dementia, delirium and depression:


A. Delirium – Sudden changes in alertness, awareness, or speech developing over days or weeks often with the severity of symptoms varying throughout the day

B. Dementia – Slow changes in memory and communication with symptoms developing over months or years

C. Depression – Rapid onset of symptoms that interfere with daily life and normal functioning, causes pain and lasts for a minimum of two weeks without relief

Impact on memory

A. Delirium – Confusion that fluctuates throughout the day, sometimes dramatically. All types of memory are impaired.

B. Dementia – A gradual, subtle slide with new learning most affected.

C. Depression – Concentration is difficult.


A. Delirium – Intense disorientation

B. Dementia – Persistent disorientation

C. Depression – No disorientation

Changes in sleep

A. Delirium – Changes in sleep occur hourly.

B. Dementia – Confused about time; sleep schedule is off.

C. Depression – Daily sleep disturbances/changes.

Most of us don’t know much about delirium. Its sudden onset is an important clue, but it helps to know delirium typically occurs with an infection (bladder infections are a frequent cause), changes in medication, stroke, head injury or suddenly stopping medication, alcohol or smoking. Malnutrition, dehydration, alcohol use and electrolyte imbalance can make someone more susceptible to delirium.

If you suspect someone has delirium, you can help in the time before you can get to a doctor, by keeping the room softly lit at night and turning off the TV and any sources of excess noise or stimulation. The reassuring presence of a family member or friend can help calm and orient your loved one.

It is possible for a person to have all three conditions. A person who is diagnosed with dementia may get depression if his medications change. If he gets an infection it’s possible he may experience delirium as well. It’s especially important if your loved one has dementia that you keep an eye out for changes in her behavior. If she has advanced dementia she may not be able to communicate something is wrong. Delirium may be the first, and perhaps only, clue of a medical illness or adverse medication reaction for someone with severe dementia or Alzheimer’s.

Because symptoms can be confusing, whenever you see a change in a loved one’s health, mood or behavior take him or her to the doctor to check things out. When the change is sudden or abrupt, insist upon a complete medical work-up.



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