Depression 
Depression is an emotional state characterised by exaggerated
feelings of sadness, dejection and helplessness. The
elderly have a much higher risk of depression and suicide
than the young because major losses tend to take place
in the later stages of life eg. medical illnesses, changes
in physical status, loss of income on retirement, death
of parents and friends, loss of a life partner and changes
in accommodation arrangements.
Many depressions are missed or thought
of as normal by the family and hence undetected. Early
detection and proper treatment is crucial to prevent
unnecessary suffering.
The common symptoms of depression include
a recent change in mood, especially pessimism, gloom
and loss of cheerfulness. There may be poor concentration,
lethargy, loss of interest in activities, a sense of
guilt, changes in appetite and sleep. There are also
abnormal symptoms of severe anxiety or bodily complaints.
Eg. the affected person may develop unnecessary worry
over apparently trivial issues, or may be constantly
seeking attention for bodily aches and discomfort. Sometimes,
depression can also cause memory changes.
Delirium
Delirium is characterised by a sudden
behavioural change, with agitation, inattention, disorientation
and memory changes which fluctuate as the day progresses.
To the family, the person affected may appear episodically
confused. Eg. a person who is independent and well can
suddenly appear perplexed and restless, sometimes acting
normal, only to become restless and agitated again hours
later. Sometimes, there is drowsiness. The sleep-wake
cycle is usually disrupted, and the fluctuations are
usually more prominent in the evenings and at night.
Delirium requires urgent medical attention
as it is associated with higher health risks. It may
be caused by infections, a minor stroke, undiagnosed
or poorly controlled diabetes, hypertension (high blood
pressure) etc. Side effects of certain medications can
sometimes cause delirium. The person presenting with
delirium for the first time often requires hospitalisation
in order to identify and treat the underlying cause.
Most patients improve with treatment. If left untreated,
delirium may progress to dementia or death.
Dementia 
Dementia is a loss of cognitive (mental)
abilities severe enough to affect social or occupational
functioning. In contrast with delirium, the symptoms
of dementia occur gradually. The loss of cognitive abilities
affects the memory, abstract thinking, problem solving,
judgement, reading, writing, drawing and speaking. The
elderly may experience poor short-term memory, encounter
difficulties navigating in the neighbourhood and finding
the right words when talking.
As dementia progresses, the elderly
will require supervision and assistance in their activities
of daily living eg. feeding, cleaning, dressing and
toilet functions. Many sufferers do not have behavioural
complications. However, when they do occur, behavioural
complications may include repeated wandering, inappropriate
social behaviour, mood swings.
Dementia may also cause behavioural
and personality changes eg. a paranoid suspicion that
others are stealing their belongings. Sometimes, some
of the behavioural symptoms may be due to a mood disorder
or a delirium. These can often be treated successfully
if identified early. As the memory loss in dementia
is usually gradual, families may not be aware of changes
till more than six months have passed.
The two most common types of dementia
are Alzheimer's Disease and Vascular Dementia. Over
50% of dementia are due to Alzheimer's disease. In this
condition, the brain cells die off at a more rapid rate
than normal, resulting in a progressive loss of cognitive
function.
Vascular dementia is the second most common type of
dementia. The underlying cause is due to ischaemia (reduced
blood flow) or accumulated strokes in various parts
of the brain. Often, there may be a background of hypertension
or diabetes mellitus, which are strong risk factors
to developing vascular dementia.
There are other less common causes
of dementia. To identify the cause of dementia accurately,
a full medical check is required, sometimes including
a CT brain scan.
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