Comparison of Clinical Features: Delirium, Dementia, and Depression

Comparison vocabulary flashcards identifying the distinct clinical features of delirium, dementia, and depression based on onset, course, progression, and various behavioral assessments.

Delirium Onset

Sudden/abrupt

Dementia Onset

Insidious/slow and often unrecognized

Depression Onset

Happens with major life changes; often abrupt but can be gradual

Delirium Course

Short, daily fluctuations in symptoms; wore at night, in darkness, and on awakening

Dementia Course

Long, no diurnal effects; symptoms progressive yet relatively stable over time; some deficits with increased stress

Depression Course

Diurnal effects, typically worse in the morning; situational fluctuations but less than with delirium

Delirium Progression

Abrupt

Dementia Progression

Slow but uneven

Depression Progression

Variable; rapid or slow but even

Delirium Duration

Hours to less than $1\,month$; longer if unrecognized and treated

Dementia Duration

Months to years

Depression Duration

At least $6\,wks$; sometimes several months to a year

Delirium Consciousness

Reduced/disturbed

Dementia Consciousness

Clear

Delirium Alertness

Fluctuates; lethargic or hypervigilant

Delirium Attention

Impaired; fluctuates; intention; distractible

Depression Attention

Minimal impairment but easily distracted

Delirium Orientation

Generally impaired; severity varies

Dementia Orientation

Generally, normal to person nut not to place or time

Depression Orientation

Selective disorientation

Delirium Memory

Recent and immediate impair; forgetful; many need instructions for simple tasks one step at a time

Dementia Memory

Recent and remote impaired

Depression Memory

Selective or patchy impairment; “islands” of intake memory; evaluation often difficult because of low motivation

Delirium Thinking

Disorganized; distorted, fragmented, illogical; incoherent speech, either slow or accelerated

Dementia Thinking

Difficulty with abstraction; thoughts diminished; judgement impaired; words difficult to find

Depression Thinking

Intact but with themes of hopelessness, helplessness, or self-depreciation

Delirium Perception

Distorted, illusions, delusions, and hallucinations; difficulty distinguishing between reality and misperception

Dementia Perception

Misperceptions usually absent

Delirium Psychomotor Behavior

Variable; hypokinetic, hyperkinetic, and mixed

Dementia Psychomotor Behavior

Normal; some have apraxia

Depression Psychomotor Behavior

Variable; psychomotor retardation or agitation

Delirium Sleep/Wake Cycle

Disturbed, cycle reversed

Dementia Sleep/Wake Cycle

Fragmented

Depression Sleep/Wake Cycle

Disturbed; usually early morning awakening

Delirium Associated Features

Variable affective changes; symptoms of autonomic hyperarousal; exaggeration of personality type; associated with acute physical illness

Dementia Associated Features

Affect tend to be superficial, inappropriate and labile (changing); attempts to hide deficits in intellect; personality changes, aphasia, agnosia sometimes present; lack insight

Depression Associated Features

Affect depressed; dysphoric mood; exaggerated and detailed complaints; preoccupied with personal thoughts; insight preset; verbal elaboration; somatic complaints, poor hygiene, neglect of self

Delirium Assessment

Distracted from task; makes numerous errors

Dementia Assessment

Failings highlighted by family, frequent “near miss” answers; struggles with test; great effort to find an appropriate reply; frequent request for feedback on performance

Depression Assessment

Failings highlighted by individual, frequent “don’t knows”; little effort; frequently gives up; indifferent towards test; does not care or attempt to find answer