Dementia vs Delirium vs
Pseudodementia
Author Unknown
What did Rihanna say to her grandma when she found out she had dementia?
“Oh Nana, What’s my name?”
Case Study
Mr. Y is a 78 year old man who was born in Korea and
moved to Canada with his wife 50 years ago. Together, the
couple opened a floral shop and ran the business for 40
years. Mrs. Y enjoyed watching her husband’s talent and
love of nature come out in his flower arrangements. When
Mr. Y was in his late 60’s, he starting having difficulty
making his favourite flower arrangements. Their son also
noticed Mr. Y misplacing tools, losing paper orders, and
forgetting important pick-up times. At home, Mrs. Y
noticed her husband having problems remembering recent
events, and waking up at odd hours in the night thinking it
was time to open the shop. Mr. Y was becoming irritable at
home and at the shop
Questions
What are Mr Y’s most prominent symptoms?
What is the most likely diagnosis?
Why is this less or more likely to be
delirium/dementia/pseudodementia?
Delirium Depression Dementia
Cardinal Features of Dementia
Evidence of significant decline from previous
performance in one or more cognitive domains –
such as complex memory, executive function,
learning, memory, language, perceptual-motor or
social cognition
Memory loss includes known information
(different from normal ageing memory loss)
Cognitive deficits interfere with activities of
daily living
Health-care providers confirmed that Mr. Y was presenting with early stage Alzheimer’s disease. At
age 75, Mr. Y was admitted to care as his wife was unable to support his needs.
Admission to long-term care:
During the first week in long-term care (LTC), the staff noticed Mr. Y pacing the hallways, pushing
on locked doors, entering other residents’ rooms. When approached by the nursing staff, he had
repetitive questions: “Who are you?”, “What do I do?”, “Where do I go?” Mr. Y required frequent
reminders that this was his new home. During meals, Mr. Y ate little despite encouragement and staff
offering assistance. During personal care such as changing, toileting and showering, Mr. Y kicked,
scratched, grabbed and screamed at the PSWs. Two staff were required during these care activities.
Socially, Mr. Y actively participated in group craft activities and exercise classes when the therapists
and staff coached him. During the times with no scheduled activities, Mr. Y paced the hallways and
asked staff: “What do I do?”, “Where do I go?”
Questions
What are his most prominent symptoms?
Wandering
Repetitive questions
Anorexia
Agitation
Confusion/disorientation
• What might be happening to him?
He is becoming depressed
His dementia is worsening
He is developing delirium
Second Week
At the end of the second week in LTC, Mr. Y was no longer pacing the halls. He was often found
napping in his room during the days. One afternoon, a PSW went into Mr. Y’s room and found him
sleeping. She tried to gently wake Mr. Y, but he was not easy to arouse. She tried a second time and
asked very loudly, “Mr. Y, it’s lunch time, are you ready to go?” Mr. Y slowly opened his eyes. The
PSW repeated her question, and Mr. Y replied slowly, “Oh, I ate last week.”…
In the dining room, Mr. Y stared out the window and did not answer the PSWs when they asked him
for his lunch preference. When approached a third time, Mr. Y rambled slowly in English and in
Korean to the PSWs. He continued to speak Korean to the PSWs as they tried to assist him with his
lunch, but he was unfocused and inattentive. He was unable to finish his meal because of his
behaviour. The staff were worried that he was not eating or drinking enough since admission…A few
nights in a row, he was found wandering outside his bedroom without his walker. One time, he told
the PSW, “Someone is looking for me.” The PSW reassured him that he is safe, and tried to direct
him back to his room
Questions
What are Mr. Y’s most prominent symptoms?
During the day: napping, not easy to arouse, disoriented, slow
movements, withdrawal, unfocused, inattentive, not eating or
drinking, falling asleep during exercise/social programs
During the night: sleep disturbance, hallucinations, increasing
disorientation
What changes might indicate delirium?
Acute timeline, decreased concentration, slow responses,
memory impairment, disorientation
Delirium
Acute confusional state which can be thought of as acute brain failure
Characterised by
Disturbance of awareness (+/- consciousness)
Changes in cognition (esp attention)
Sudden onset (hours to days)
Fluctuating course
Often also have:
Disturbance of sleep-wake cycle
Delusions / hallucinations
Generally triggered by acute precipitant(s)
Questions
Which kind of delirium do you think Mr. Y is most likely
presenting with?
Mixed – alternating hyperactive and hypoactive symptoms.
At night: wandering, restless, agitated and experiencing
delusions. During the day: sleep, slowed
movements/responses and apathetic.
Delirium Type
Hyperactive
Restlessness, agitation, delusions, and/or aggressive behaviour.
Hypoactive
Lethargy, drowsiness, slowed movements and disinterested behaviour
Mixed
Phases of hyperactive and hypoactive delirium
Questions
Is Mr Y. showing any signs of behaviour and psychological
symptoms of dementia (BPSD)?
During the day: napping, not easy to arouse, disoriented, slow
movements, withdrawal, unfocused, inattentive, not eating or
drinking, falling asleep during exercise/social programs
During the night: sleep disturbance, hallucinations, increasing
disorientation
Is Mr. Y showing any signs of depression?
Sleep disorder, interest deficit, energy deficit,
concentration deficit, decreased appetite
BPSD
BPSD is an umbrella term for a group of symptoms associated with dementia
Apathy
Depression / Anxiety
Agitation
Aggression
Disinhibition
Psychosis (delusions / hallucinations)
Depression Symptoms
SIGECAPS:
Sleep Disorder (increased or decreased)
Interest deficit (anhedonia)
Guilt (worthlessness, hopelessness, regret)
Energy deficit
Concentration deficit
Appetite disorder (increased or decreased)
Psychomotor retardation or agitation
Suicidality
Questions
Mr. Y appears to have delirium. Do you think the delirium symptoms could be
mistaken for either depression or dementia?
• His hyperactive delirium states can resemble BPSD
• His hypoactive delirium states can resemble depression
