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Posted: June 14th, 2023
Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression
Dementia, delirium, and depression are all common mental health conditions that can affect older adults. While they can share some symptoms, they are distinct conditions with different causes and treatments.
Dementia is a chronic, progressive brain disorder that causes a decline in cognitive function. This can include problems with memory, thinking, judgment, and language. Dementia is not a single disease, but rather a group of diseases that can affect the brain. The most common types of dementia are Alzheimer's disease, vascular dementia, and Lewy body dementia.
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Delirium is a sudden, acute change in mental status that can be caused by a variety of factors, including infection, medication side effects, or a medical condition. Delirium can cause a wide range of symptoms, including confusion, agitation, hallucinations, and changes in sleep-wake patterns.
Depression is a common mental health condition that can affect people of all ages. Depression can cause a variety of symptoms, including sadness, loss of interest in activities, changes in sleep and appetite, and difficulty concentrating.
Assessing
The assessment of dementia, delirium, and depression can be challenging, as the symptoms of these conditions can overlap. A thorough assessment will include a medical history, physical exam, and mental status exam. The assessment may also include laboratory tests, imaging studies, and neuropsychological testing.
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Diagnosing
The diagnosis of dementia, delirium, and depression is based on the results of the assessment. The diagnosis of dementia requires a decline in cognitive function that is severe enough to interfere with daily activities. The diagnosis of delirium requires a sudden change in mental status that is caused by a medical condition or medication side effect. The diagnosis of depression requires the presence of a number of symptoms that have lasted for at least two weeks.
Treating
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The treatment of dementia, delirium, and depression varies depending on the underlying cause of the condition. There is no cure for dementia, but there are treatments that can help to slow the progression of the disease and manage the symptoms. Treatment for delirium typically focuses on treating the underlying cause of the condition. Treatment for depression may include medication, therapy, or a combination of both.
Support
People with dementia, delirium, and depression often need support from their family and friends. There are also a number of support groups and resources available to help people with these conditions and their families.
If you are concerned that you or someone you know may have dementia, delirium, or depression, it is important to see a doctor for evaluation. Early diagnosis and treatment can help to improve the quality of life for people with these conditions.
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Number of sources: 4
Paper instructions:
With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as an advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care.
To prepare:
Review the case study provided by your Instructor. Reflect on the way the patient presented in the case, including whether the patient might be presenting with dementia, delirium, or depression.
Reflect on the patient’s symptoms and aspects of disorders that may be present. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
Access the Focused SOAP Note Template in this week’s Resources.
The Assignment:
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Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:
Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results? How would you interpret and address the results of the Mini-Mental State Examination (MMSE)?
Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other healthcare providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.
Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.
Week 2
Case Study 1:
HPI: Ms. Peters is a 70-year-old female who is brought to your office by her son with reports of acute confusion (more than usual) and some agitation and restlessness. She has a known history of dementia, managed with Aricept 10 mg. daily. Her son, Jared, reports that 2 days ago she began to become more confused than usual and very easily agitated. He reports that yesterday, she couldn’t remember where she was in her own home. She had a doctor’s appointment 3 days ago and her HCTZ (hydrochlorothiazide) was increased to 50 mg. due to increased bp’s.
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Ms. Peter’s last Mini-Mental State Exam (MMSE) score was 18/30. The assessment was repeated, and the score remained unchanged.
Ms. Peters and her son denies her having any falls or contributing traumas recently. She denies any changes in diet or routine regimens. No reported dysuria, no fever, nausea, or vomiting.
Note: Be sure to review the MMSE and how to interpret results (Mental State Assessment Tests). Make sure you document the patient’s score in your SOAP note document. Also review the Geriatric Depression Assessment (Geriatric Depression Scale [GDS]).
Ms. Peters is a 70-year-old female who is alert but easily distracted, at times, during today’s clinical interview. Her eye contact is fair. Speech is clear and coherent but tangential at times. She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She is alert but disoriented to place and time. She denies any falls, denies any pain. Her son does say she has had some “stumbling” and balance issues but no reported falls.
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All other Review of System and Physical Exam findings are negative other than stated.
Vital Signs: 98.1 120/64 HR-72 20
PMH: Hypertension, Diabetes, Osteoporosis, Chronic Allergic Rhinitis
Allergies: Atorvastatin
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Medications:
Multivitamin daily
Losartan 50mg daily
HCTZ 50mg daily
Fish Oil 1 tablet daily
Glyburide 5mg daily
Metformin 500mg BID
Donepezil 10mg daily
Alendronate 70mg orally once a week
Social History: As stated in Case Study
ROS: As stated in Case study
Diagnostics/Assessments done:
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CXR—no cardiopulmonary findings. WNL
CT head—diffuse Cerebral Atrophy
MMSE—Ms. Peters scored 18 out of 30 with primary deficits in orientation, registration, attention and calculation, and recall at a previous visit. At today’s visit, there is no change. The score suggests moderate dementia.
Hemoglobin A1C7.2%
Basic Metabolic Panel as shown below
TEST
RESULT
REFERENCE RANGE
GLUCOSE
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90
65–99
SODIUM
130
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135–146
POTASSIUM
3.4
3.5–5.3
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CHLORIDE
104
98–110
CARBON DIOXIDE
29
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19–30
CALCIUM
9.0
8.6–10.3
BUN
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20
7–25
CREATININE
1.00
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0.70–1.25
GLOMERULAR FILTRATION RATE (eGFR)
77
>or=60 mL/min/1.73m2
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