Ask Miriam – July 2023
Dear Miriam,
My wife is 67 years old, and we have been married for 45 years. We have two sons, but only one of them lives close by with his young family, and I worry about burdening him. My wife has had a number of serious health issues lately and was even in the Intensive Care Unit for a week, but she has been home now for several weeks, and she seems confused and uncommunicative. When she was in the hospital, sometimes she didn’t know who I was. She didn’t remember what was wrong with her or why she was there, and her doctor mentioned something called “delirium.” I feel like it is a little better now, but she is still mixing up who everyone is, and she seems to be seeing people who aren’t there. When I ask her about these “people,” she says she is sure that they are there to steal her jewelry. Since she’s been home, she doesn’t call any of her old friends, and she just stares at the TV for hours. Do you think she has dementia?
—Distressed
Dear Distressed,
Thank you for reaching out and sharing your concerns about your wife’s recent changes in behavior and well-being. The symptoms you’ve described can be associated with several different conditions that look similar, but sometimes it can be hard to tell one from the other: dementia, depression, and delirium.
What is the difference between these?
Delirium is a neuropsychiatric (brain-related) syndrome that can happen because of an event, such as a change in medication, a urinary tract infection, or a hospitalization. It is usually temporary and can be reversed once the reason is identified.
Depression is typically associated with a low mood and loss of pleasure or interest in activities. Medication and/or therapy can be helpful in treating depression.
Dementia, however, is a progressive brain disease that takes years to develop, and it is not reversible.
For example, in the beginning of Alzheimer’s disease, the most common form of dementia, short-term memory is generally affected first, but someone with delirium may also not remember things. It may be hard to tell if someone is isolating themselves because their memory is impaired (dementia) or because they are feeling hopeless, which can be a symptom of depression.
Since delirium and depression can cause cognitive changes that may be mistaken for dementia, the most important step to take is to connect with your wife’s primary care physician. Make a list of her symptoms, describe what her behavior was like before her hospitalization and after it, including the time leading up to the doctor’s appointment. This may be a valuable tool in helping the physician make a diagnosis. Note any patterns or triggers for her behaviors. Depending on the initial assessment, you may need to consult with a specialist such as a geriatric psychiatrist or a neurologist.
During this time, try to offer comfort and solace to your wife. She may or may not be aware of the changes within herself, but if she is diagnosed with dementia, it will be important for both of you to get support as you cope with the changes in your lives.
For more information on memory loss and Alzheimer’s disease, and to find out about the many services available for people with Alzheimer’s or another dementia and their caregivers, please call the Alzheimer’s Los Angeles Helpline at 844-435-7259.
Best,
Miriam
Questions for Miriam can be sent to askmiriam@alzla.org.