Differential Diagnosis in Older Adults: Dementia, Depression, and Delirium

Abstract

Research shows that misdiagnosis can have particularly damaging consequences in older adults. It is frequently difficult, however, to determine whether observed symptoms are due to aging or to a medical condition. The author examines three common disorders that can be particularly challenging to diagnose in older adults: dementia, depression, and delirium. Three general questions are discussed for each: What are the age‐related differences in the disorder's presentation? What medical issues need to be ruled out? What assessment methods are particularly useful in the diagnostic process?

Cognitive Impairment in Hip Fracture Patients: Timing of Detection and Longitudinal Follow‐Up

“…Although delirium and dementia are potentially distinguishable, they are related and often difficult to differentiate 15,16 . Premorbid cognitive impairment such as dementia is a major predisposing factor for delirium in the hospital, 6,17,18 and in the elderly, delirium often does not have a sudden onset and may have longer duration 2 .…”

Screening for Medical and Neurodevelopmental Disorders for the Professional Counselor

“…In this regard, neuropsychological tests can be profitably used to differentiate an early stage dementing process from a primary depressive disorder in elderly clients (Pollak, Levy, & Robin, 1995). With the aging of the population, this has become an increasingly frequent diagnostic question confronted by counselors (Gintner, 1995;Hill & Spengler, 1997).…”

“…M edical and neurodevelopmental disorders, which can be mistaken for a primary mental disorder, have received increased attention in the recent counseling literature (Albrecht & Wallace, 1998;Erk, 1997;Gintner, 1995;Hill & Spengler, 1997;Keeling, 1993). (Reader Note.…”

Psychometric Properties of the Depressive Symptom Assessment for Older Adults in Individuals with Moderate or Severe Dementia

“…Previous depression assessment instruments for older adults have targeted individuals with or without dementia, but not both populations (Brodaty & Luscombe, 1996;Gintner, 1995;Lam et al, 2004;McCabe et al, 2006;Snowden, Sato, & Roy-Byrne, 2003;Sunderland, Alterman et al, 1988). One unique aspect of the Depressive Symptom Assessment for Older Adults (DSA) is that it measures depression in older adults regardless of cognitive status (Onega, 2008).…”

“…Assessment of depression in this population is challenging because communication skills are impaired with moderate or severe dementia and symptoms of depression and dementia frequently overlap (Brodaty & Luscombe, 1996;Gintner, 1995;Kunik et al, 2005;Lam et al, 2004;Moretti et al, 2002;Onega, 2006;Rovner et al, 1990).…”