title: Geriatric psychiatry review: differential diagnosis and treatment of the 3 D's - delirium, dementia, and depression.
abstract: The three D's of Geriatric Psychiatry-delirium, dementia, and depression-represent some of the most common and challenging diagnoses for older adults. Delirium is often difficult to diagnose and treatment is sometimes controversial with the use of antipsychotic medications, but it is common in a variety of patient care settings and remains an independent risk factor for morbidity and mortality in older adults. Dementia may affect a significant number of older adults and is associated with delirium, depression, frailty, and failure to thrive. Treatment of dementia is challenging and while medication interventions are common, environmental and problem solving therapies may have some of the greatest benefits. Finally, depression increases with age and is more likely to present with somatic complaints or insomnia and is more likely to be reported to a primary care physician than any other healthcare provider by older adults. Depression carries an increased risk for suicide in older adults and proven therapies should be initiated immediately. These three syndromes have great overlap, can exist simultaneously in the same patient, and often confer increased risk for each other. The primary care provider will undoubtedly benefit from a solid foundation in the identification, classification, and treatment of these common problems of older adulthood.
authors: Department of Medicine, Division of Geriatrics and Aging, University of Rochester School of Medicine and Dentistry, Monroe Community Hospital, Rochester, NY 14620, USA. Lisa_Downing@URMC.Rochester.edu
authors: Lisa J
authors: LJ
authors: Downing
authors: Thomas V
authors: TV
authors: Caprio
authors: Jeffrey M
authors: JM
authors: Lyness
mesh_terms: D000368:Aged; D003693:Delirium / Q000175:diagnosis / Q000628:therapy; D003704:Dementia / Q000175:diagnosis / Q000628:therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy; D003937:Diagnosis, Differential; D006801:Humans
references: Mayo Clin Proc. 2012 May;87(5):437-42
references: 22560523
references: Aging Clin Exp Res. 2009 Feb;21(1):38-42
references: 19225268
references: J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):255-63
references: 15031310
references: Arch Gen Psychiatry. 2012 Oct;69(10):1073-9
references: 23026957
references: JAMA. 2011 Sep 28;306(12):1359-69
references: 21954480
references: JAMA. 2012 May 23;307(20):2177-84
references: 22618925
references: J Am Board Fam Med. 2010 Mar-Apr;23(2):260-9
references: 20207936
references: Am J Psychiatry. 2009 Dec;166(12):1375-83
references: 19833788
references: Sleep. 2011 Dec 01;34(12):1715-21
references: 22131610
references: Arch Gen Psychiatry. 2011 Jan;68(1):33-41
references: 21199963
references: Ann Intern Med. 1990 Dec 15;113(12):941-8
references: 2240918
references: J Clin Psychiatry. 2010 Jan;71(1):74-9
references: 20129007
references: N Engl J Med. 2011 Dec 29;365(26):2447-9
references: 22204721
references: Am J Med. 2010 Dec;123(12):1087-90
references: 20870196
references: Pharmacology. 2010;86(4):203-15
references: 20829645
references: Am J Clin Nutr. 2012 Jul;96(1):208-14
references: 22648722
references: Int Psychogeriatr. 2009 Feb;21(1):138-47
references: 18925978
references: Geriatrics. 2009 May;64(5):10-8
references: 19435390
references: J Am Geriatr Soc. 2012 Nov;60(11):2005-13
references: 23039270
references: JAMA. 2008 Dec 24;300(24):2867-78
references: 19109115
references: J Gerontol Nurs. 2010 May;36(5):47-52
references: 20349850
references: Int Psychogeriatr. 2012 Nov;24(11):1855-64
references: 22647266
references: J Psychiatr Res. 2011 May;45(5):569-76
references: 20951997
references: Arch Phys Med Rehabil. 2011 Dec;92(12):2025-7
references: 22133252
references: JAMA. 2010 Jul 28;304(4):443-51
references: 20664045
references: J Gerontol A Biol Sci Med Sci. 2013 Jan;68(1):62-7
references: 22511289
references: Arch Intern Med. 2011 Oct 10;171(18):1625-33
references: 21987192
references: Practitioner. 2012 Jan;256(1747):17-20, 2-3
references: 22720455
references: Am J Psychiatry. 2001 May;158(5):712-7
references: 11329391
references: J Gen Intern Med. 2006 Sep;21(9):926-30
references: 16918736
references: Int Psychogeriatr. 2009 Feb;21(1):60-8
references: 18786280
references: Lancet Neurol. 2012 Oct;11(10):851-9
references: 22959217
references: Aging health. 2009 Feb 1;5(1):61-78
references: 19956796
references: Behav Sleep Med. 2006;4(2):104-13
references: 16579719
references: Am Fam Physician. 2012 Jan 15;85(2):139-44
references: 22335214
references: Prim Care Companion CNS Disord. 2012;14(4):
references: 23251860
references: J Am Geriatr Soc. 1990 Nov;38(11):1235-8
references: 2246460
references: Int Psychogeriatr. 2012 Aug;24(8):1347-53
references: 22436131
references: PLoS One. 2012;7(6):e38268
references: 22675535
references: JAMA. 2003 Jun 4;289(21):2819-26
references: 12783912
references: Am J Geriatr Psychiatry. 2010 Dec;18(12):1146-54
references: 20808098
references: J Nutr Health Aging. 2013 Jan;17(1):35-8
references: 23299376
references: Psychosomatics. 2012 Sep-Oct;53(5):439-45
references: 22902084
references: Behav Sleep Med. 2012 Oct;10(4):266-79
references: 22946736
references: Cochrane Database Syst Rev. 2008 Oct 08;(4):CD004514
references: 18843658
references: Am J Psychiatry. 2006 Sep;163(9):1493-501
references: 16946172
references: J Am Geriatr Soc. 2009 May;57(5):761-89
references: 19484833
references: Brain. 2012 Sep;135(Pt 9):2809-16
references: 22879644
references: Psychiatr Clin North Am. 2012 Mar;35(1):203-29
references: 22370499
references: N Engl J Med. 2007 Nov 8;357(19):1939-45
references: 17989386
references: Int Psychogeriatr. 2012 Nov;24(11):1749-55
references: 22687278
references: JAMA. 2008 Nov 19;300(19):2253-62
references: 19017911
references: J Am Geriatr Soc. 2011 Oct;59(10):1829-36
references: 22091496
references: Ther Adv Neurol Disord. 2013 Jan;6(1):19-33
references: 23277790
references: Psychiatr Serv. 1997 Nov;48(11):1415-9
references: 9355168
references: J Palliat Med. 2012 Apr;15(4):438-46
references: 22500481
references: J Am Geriatr Soc. 2011 Nov;59 Suppl 2:S269-76
references: 22091572
references: Int J Geriatr Psychiatry. 2013 Feb;28(2):190-8
references: 22495689
references: J Am Geriatr Soc. 2010 May;58(5):880-8
references: 20406320
references: Int Psychogeriatr. 2012 Aug;24(8):1265-74
references: 22333477
references: Arch Gen Psychiatry. 2010 May;67(5):507-16
references: 20439832
references: J Clin Oncol. 2012 Apr 10;30(11):1206-14
references: 22412123
references: Int J Geriatr Psychiatry. 2011 Sep;26(9):937-43
references: 21845596
references: Cochrane Database Syst Rev. 2012 Jun 13;(6):CD005379
references: 22696350
references: Arch Gen Psychiatry. 2012 Feb;69(2):150-8
references: 22213770
references: Br J Psychiatry. 2012 Jul;201(1):40-5
references: 22626634
references: Geriatrics. 2009 Apr;64(4):20-6
references: 19400596
references: N Engl J Med. 2012 Jul 5;367(1):30-9
references: 22762316
references: J Gerontol Soc Work. 2012;55(5):382-91
references: 22783956