Deciphering the 4 D's: cognitive decline, delirium, depression and dementia – a review

Abstract

It is essential to understand how the 4 'D's' are expressed and to recognize the potential contributing factors to an observable change in cognitive function for diagnosis and treatment. Recommendations for obtaining a person's history are included.

Validation of the Greek version of confusion assessment method for the intensive care unit (CAM-ICU)

“…Since delirium is fluctuating, a one-time only assessment may fail to detect it. Thus bedside nurses are in a unique position to screen and diagnose delirium not only in the ICU but also in other settings, as they have contact with patients for an entire 8 or 12 hour shift (Insel and Badger, 2002;Pun et al, 2005). Critical care nurses using the CAM-ICU are able to complete delirium assessment in an average of 2 minutes with an accuracy of 98%, compared to a full DSM-IV assessment by a psychogeriatrician expert, who usually requires at least 30 minutes to complete the assessment (Ely et al, 2001b).…”

Integrate Literature Review of Delirium on the Elders

“…Additionally, delirium problems in elderly patients are similar to the symptoms of dementia and depression [2,8,15] which might confuse health care professionals and create further difficulties in caring for elderly patients with 3D (delirium, dementia, depression). Therefore, the authors also suggest developing a 3D assessment scale to distinguish between the three problems and reduce misdiagnosis rates, which would result in reduced hospitalization times, death rates, cost to the health care system, and patients being transferred to nursing homes.…”

“…Demographic and physical factors are age, gender, hospitalized days, institutionalization, trauma history, surgery, heart and lung illness, hypertension, diabetes, chronic kidney failure, gastrointestinal diseases, urinary and genital illness, metabolic disorders, central nervous system illness, peripheral vascular disease, stroke, dementia, malnutrition, fever, low albumin, low oxygen, dehydration, electronic imbalance, azotemia, infection, convulsion, and multiple or pain medications [1,2,4,5,[7][8][9][11][12][13][14][15][16][17][18]. Specifically, 3% to 5% of elderly people who have had hip and knee surgeries would experience acute confusion or delirium for a specific period.…”

“…The assessment scales [1,2,4,5,[7][8][9][10][11][12][14][15][16] used to measure elderly delirium include medical diagnosis systems such as DSM-III-R, DSM-IV, and DSM-IV-TR, as well as cognitive assessment scales such as the short portable mental status questionnaire (SPMSQ) [20], the minimental status examination (MMSE) [21], the confusion assessment method-ICU (CAM-ICU) [22,23], the Groningen Frailty Indicator (GFI) [24] and Hasegawa's Dementia Scale-Revised (HDS-R) [25].…”

Differentiating among Depression, Delirium, and Dementia in Elderly Patients

“…Once medical contributors have been ruled out, depression, characterized by a more pervasive or chronic low-mood state with or without cognitive impairment should be considered. Patients with dementia are less likely to self-report their cognitive problems than are patients with depression (see table 1) [22,23]. …”