Dementia – Depression Delirium
Understand the relationship, Recognize the signs and
symptoms
Dementia Care Training Centre - 2007
No More Business as Usual
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Dementia Care Training Centre
Guiding principles
Sharing our story
Outcomes
Lessons learned
Dementia Care Training Centre
A core business of Alzheimer Society of
Calgary
Includes staff training and family education
Guiding Principles
Person-centred
Outcomes driven
Supporting Excellence in Dementia Care
What was happening in Calgary
More than 10,000 people diagnosed with
Alzheimer’s disease
Limited recognition of delirium among
direct care providers
Cognitive Impairment Strategy
National Guidelines for Seniors Mental
Health
Alzheimer Society Responsibility
“No one in a better position than the Alzheimer
Society to educate staff and families about the
importance of delirium”
“Staff need to recognize the symptoms, who and
how to report what they see”
Sharing Our Story
Workshop Learning Objectives
To understand the terms dementia, depression & delirium
To recognize the signs and symptoms of dementia,
depression and delirium
To appreciate the difficulty of co-existence and
interrelations of the dementia, depression, delirium
To understand the diagnostic process
To appreciate a person-centred approach to care
Workshop Outline
The Marvellous Healthy Brain
Causes of Cognitive Impairment
Functions & Damages of the Brain
Irreversible Types of Dementia
Reversible Causes of Dementia
Depression & Delirium
Understanding the Distinctions
The Diagnostic Process
Person-Centered Care
The Healthy Brain - Introduction
The brain weighs approx. 3 lbs. – 7 cups
Structural & Functional Organization
The brain consists of brain cells
(neurons) that connect to each other
through their axons, dendrites and
synaptic connections.
Neural networks: 1012 (100 billion)
neurons has on average 7k-10k
connections (total 1000 trillion).
another SENSATIONal fact:
“the little man”
Homunculus
Causes of Cognitive Impairment
developmental disabilities
brain injury
mild cognitive impairment
dementia
What is Dementia?
Areas of the Brain
Structure & Functions
Limbic System
Non-Reversible Types of Dementia
Others:
Alzheimer’s disease
Vascular Dementia
Dementia with Lewy
bodies
Fronto-Temporal
Dementia
Parkinson’s Disease
Huntington’s
Disease
Creutzfeldt Jakob
Disease
Progressive
Supranuclear Palsy
Korsakoff’s
Syndrome
Infection-Related
Dementia (HIV,
Syphilis)
Reversible Causes of Dementia
Malnutrition
Dehydration
Metabolic Dysfunction
Vitamin B12 Deficiency
Depression
Delirium
Depression
Signs & Symptoms:
Sad or depressed most of the time (mood)
“emptiness”
Feelings of anxiety (various forms) and
psychomotor agitation
Changing appetite and weight loss/gain
Sleep Disturbances
Loss of interest/Lack of motivation
Concentration or Memory problems
Social Withdrawal
Thoughts of death/Suicidal Risk
Depression in the Elder Population
Common atypical features :
Psychotic features (paranoid
delusions)
Somatization
The “dwindles” (*)
Potential Issues:
Suicide risk is high
Depression is an unusual sole
cause of cognitive impairment
Depression often co-exists with
dementia
Vincent van Gogh, who himself
suffered from depression and
committed suicide, painted this
picture in 1890 of a man that can
symbolize the desperation and
hopelessness felt in depression.
Delirium – Core Features (DSM-IV)
Disturbance in consciousness (i.e., reduced
clarity of awareness of the environment) with
reduced ability to focus, sustain, or shift attention;
A change in cognition (i.e., memory deficit,
disorientation, language disturbance) or the
development of a perceptual disturbance that is not
better accounted for by a preexisting, established,
or evolving dementia; and
The disturbance develops over a short period of
time (usually hours to days) and tends to fluctuate
during the course of the day.
Delirium can occur as a consequence of
A general medical condition
Substance intoxication
Substance withdrawal
Multiple causes
Often arises as an interplay of predisposing and
precipitating factors.
Furthermore:
In general, the greater the vulnerability of the
person, the higher the likelihood of delirium
occurring.
It is not always possible to firmly establish the
specific etiology of the delirium in an older person.
Comparison of the Clinical Features
Dementia
Depression
Delirium
Insidious/slow and
often unrecognized;
depends on cause
Coincides with major
life changes; often
abrupt, but can be
gradual
Sudden/abrupt;
depends on cause;
often at twilight or in
darkness
Clinical Features:
ONSET
COURSE, PROGRESSION, ATTENTION,
MEMORY, THINKING
Principles of Person Centred Care
Uniqueness
Complexity
Enabling
Personhood
Value of others
Outcomes
40 people trained
3 workshops to date
Participants: acute care, long-term care,
developmental disabilities, adult day
support, independent seniors residences,
seniors community resources, Calgary and
Edmonton health region
I have an understanding of the term dementia…
(N=15)
100%
90%
80%
69%
70%
67%
60%
PRIOR
50%
AFTER
40%
33%
30%
25%
20%
10%
6%
0%
0%
0%
0%
0%
0%
Strongly Disagree
Disagree
No Opinion - Neutral
Agreement
Agree
Strongly Agree
I understand the various consequences of dementia…
(N=15)
100%
90%
80%
70%
63%
60%
60%
PRIOR
50%
AFTER
40%
40%
30%
19%
20%
13%
10%
6%
0%
0%
0%
0%
0%
Strongly Disagree
Disagree
No Opinion - Neutral
Agreement
Agree
Strongly Agree
I understand the relationship between dementia, depression and dleirium…
(N=15)
100%
90%
80%
70%
60%
60%
PRIOR
50%
AFTER
40%
40%
40%
30%
27%
20%
13%
10%
13%
7%
0%
0%
0%
0%
Strongly Disagree
Disagree
No Opinion - Neutral
Agreement
Agree
Strongly Agree
Lessons Learned
Direct care providers across the care continuum
recognize their need to learn more about
dementia, depression and delirium and reporting
requirements
Family members are beginning to recognize the
importance of understanding the relationship
between dementia, depression and delirium
The Alzheimer Society plays a key role in
educating and supporting staff and families
about delirium
Thank you!
If you have any questions or comments,
please contact us at
Telephone: 290-0110
Email: info@alzheimercalgary.com
or have a look at our website:
www. AlzheimerCalgary.com