Health information
The three Ds
Dementia
Delirium
Depression
As we get older, we have a higher risk
of getting various health conditions.
These include dementia, delirium and
depression. These are three separate
conditions, but their symptoms and
risk factors can overlap. Because of
this, it can be easy for relatives, friends
and even healthcare professionals to
mistake one condition for another.
This series of factsheets explains the
conditions, some of the similarities and
differences between them, and what
can help you tell them apart if you’re
concerned about a loved one.
bupa.co.uk
What is dementia?
Signs of dementia
Dementia and depression
Rather than one specific condition,
the term ‘dementia’ refers to a set of
symptoms, including problems with
thinking, reasoning, learning, memory
and language, and difficulties with
daily activities.
Dementia has lots of possible
symptoms, depending on the person
and the type of dementia.
The main ones are outlined here:
Depression is a common and
treatable condition where someone
has a persistently low mood and/or
little interest or pleasure in activities,
as well as other symptoms.
Some of the symptoms of depression
are similar to those of dementia, for
example:
Emotional and behavioural problems
● being
Dementia can be caused by a wide
range of different underlying diseases.
The most common ones are:
Alzheimer’s disease
This is the most common cause of
dementia, caused by parts of the
brain shrinking and certain proteins
building up in the brain. The early
signs are usually memory lapses, and
the condition steadily gets worse over
time.
Vascular dementia
This is the second most common
cause of dementia, and often starts
after a stroke or ‘mini-stroke’. Over
time it gets worse, usually in big
‘steps’, rather than gradually
Dementia with Lewy bodies
This is caused by certain proteins
building up in nerve cells. There may
be some additional symptoms, such
as hallucinations, or movement
problems similar to Parkinson’s
disease.
Frontotemporal dementia
This is quite a rare cause of dementia; it involves cells dying in specific
parts of the brain. Symptoms may be
quite different – involving language,
personality and behaviour first, rather
than memory.
Dementia gets worse over time.
Problems can be quite mild to start
with, but will eventually disrupt the
person’s daily life, and often end up
with them needing residential care.
Sadly there is no cure for dementia.
There are a handful of treatments
that can slow down the progression
of symptoms in the early and middle
stages of Alzheimer’s disease.
withdrawn or apathetic
● feeling
low or anxious
● appearing
● being
suspicious
irritable and aggressive
● restlessness
or trouble sleeping
Difficulties with daily activities
● getting
lost in familiar places
● problems
with domestic routine,
like forgetting a recipe or
neglecting chores
● developing
unhygienic habits or
neglecting appearance
Difficulties with remembering,
thinking and language
● memory
problems like
forgetfulness, repeating the same
question, difficulty finding the
right word
● difficulty
reading or following a
conversation
● being
disorientated
● being
disoriented or withdrawn
● feeling
apathetic or uninterested
● difficulty
concentrating
Because of these similarities it can
be hard to tell the two apart, and a
person who actually has dementia
may be wrongly diagnosed as having
depression (or vice versa). Even some
of the ways that professionals test
for dementia, such as thinking and
memory tests, are not necessarily
reliable. This is because depression
can affect the scores that someone
gets on these tests.
To make things more complicated,
depression is also one of the
symptoms that can result from
dementia. In fact, around one-third of
people with dementia also develop
depression at some stage. So just
because a person has a diagnosis of
dementia, it doesn’t necessarily mean
they don’t also have depression.
For more information on depression,
see the factsheet The three Ds:
Depression.
Dementia and delirium
Telling the three Ds apart
Delirium is a common and treatable
condition where someone is severely
confused. It can have symptoms
similar to those of dementia, for
example:
There are some distinct features of
the three conditions that can help you
to try and work out what the problem
might be if you are worried about a
loved one.
● being
A person with depression will not
have their memory affected as badly
as a person with dementia. Their
thoughts will probably be more
consistently negative, with feelings of
low self-esteem and helplessness.
confused and disoriented
● becoming
irritable, aggressive or
paranoid
● being
apathetic or withdrawn
Because of these similarities, and the
fact that older people are at increased
risk of delirium, it can sometimes be
hard to tell the two apart. And again,
an existing diagnosis of dementia
does put someone at a higher risk of
delirium. This means that an episode
of delirium may be mistaken for
someone’s dementia suddenly getting
worse (or vice versa).
For more information on delirium, see
the factsheet The three Ds: Delirium.
A person with delirium will be more
severely confused, and may be
particularly agitated or lethargic. These
are not common in dementia (unless
the person is in the later stages or has
dementia with Lewy bodies). Someone
with delirium will probably have
particular difficulty concentrating and
be easily distracted.
Another thing to look for is how
quickly symptoms have appeared.
Symptoms of dementia tend to come
on very gradually. With depression
they will come on more rapidly,
typically over a number of weeks or
months. With delirium they can be
even more sudden: a matter of hours
or days. With delirium, symptoms are
generally worse at night, when the
person may be particularly confused
or disoriented, or experience paranoia
or hallucinations.
It can help to know what the
underlying causes of the other
conditions are, particularly in the case
of delirium. It can be brought about
by infections, reactions to certain
drugs and pain (among other things).
For more details, see the factsheet
The three Ds: Delirium.
If it is unclear whether dementia is
causing certain symptoms, or whether
depression and/or delirium are
involved, healthcare professionals will
often choose to treat for depression
or delirium first. If the symptoms don’t
improve they may be able to rule out
depression or delirium, and can then
do further assessments for possible
dementia.
In cases where a person has dementia
and depression/delirium, again the
doctor should focus on treating the
depression or delirium first.
Looking after a person
with dementia
A clear diagnosis of dementia and
an understanding of the person’s
individual needs, without the
complicating factors of delirium of
depression, means positive steps can
be taken to help the person live well
with the condition.
Depending on the person’s diagnosis,
a doctor may prescribe some
medicines for them. However, these
do not cure dementia; they are
designed to slow down symptoms.
This effect is only temporary, and
most of the medicines only work for
people in the early or middle stages
of Alzheimer’s disease.
Caring for a person with dementia
is generally focused on addressing
the problems that the dementia may
cause, and creating a supportive
environment for the person. This may
include:
Psychological support.
Some strategies can help the person
adjust to their condition and feel more
in control.
Activities and stimulation.
Regular, enjoyable activities may
enhance the person’s quality
of life and help them maintain
independence and mobility for longer.
Changing the physical environment.
This could include mobility aids,
prompts and reminders, and
uncluttered rooms.
Complementary and alternative
therapies.
Practices such as aromatherapy and
massage may help a person with
dementia to relax.
Dementia key points
?
A set of symptoms
with memory,
thinking and language
l
problems
emotional and behavioural
problems
l
l
difficulties with daily activities
Different possible causes
Possible similarities
to depression
l
disoriented
l
apathetic
l
difficulty
l
Alzheimer’s
l
vascular
l
dementia
l
frontotemporal
dementia
with Lewy bodies
l
confused
or uninterested
l
irritable,
l
apathetic
concentrating
More likely with depression
memory
l
consistently
dementia
Possible similarities
to delirium
or withdrawn
l
disease
loss not as bad
negative thoughts
symptoms come on over weeks
or months
l
and disoriented
aggressive or paranoid
or withdrawn
More likely with delirium
l
severely
confused
l
either
l
symptoms
agitated or lethargic
come on over hours
or days
l
symptoms
may be worse at night
Looking after a person with dementia
drug treatments can slow down symptoms in
early or middle-stage Alzheimer’s disease
l
some
support can help a person adjust to
their condition
l
psychological
an improved physical environment can help a person
to live well
l
l
some
complementary and alternative therapies may help