Is elderly confusion depression or dementia?

If there is no improvement in a few months he should have a much more thorough exam with a neuro psych doctor. I doubt this is depression.

My mother's been depressed her whole entire life and it's never manifested itself in Memory loss, not realizing she's home when she is, or Sundowning. All those symptoms started when she was diagnosed with dementia in 2016 and have gotten progressively worse. I don't think there's a blueprint as to when Sundowning should or should not start in an elder suffering from dementia, just as all the symptoms wax and wane quite a bit. My mother is now 94 and has days where she's quite lucid and others where she's getting ready to ride the bus to NYC from Colo to see her papa who's been dead since 1949.

My father was 91 when he was hospitalized with a broken hip. After surgery and general anesthesia, then I saw Sundowning and mass confusion, out of nowhere. It lasted about a week and then cleared up.

If you think your dad is reacting to being taken off of a statin, wait 3 weeks and see if he improves. If not, you'll know it's not the meds.

You say dad "passed" the MMSE.....what score did he get out of 30? Mom got a 19 on her first go around and was dxed at that time, with that score, with progressive dementia. The drawing of the clock was key; she was unable to do it which indicates an executive brain function impairment.

Like Alva said, if you see no improvement in dad here soon, get him to the doctor for better testing.

Good luck!

The short term memory issues, and not tracking/remembering where he is are the only two symptoms my dad has of moderate dementia. My dad’s doctor said he was fine too, but my mom pushed to have him seen by a Geri neurologist who diagnosed the dementia with scans. He’d had noticeable issues for 3 years before he finally got diagnosed. Now he fell in November and had a brain injury that led to Major Depressive Disorder, and that manifested in a lot of “I don’t know”, “whatever” and “I can’t think about that right now“ answers to questions because he didn’t want to engage with me at all; now that he’s on good meds he is back to baseline (which is short term memory issues and needing to be reminded where he is).

Symptoms of depression and dementia can be very similar, hard to differentiate and co-exist. The doctor has a baseline MMSE result and can compare a follow up exam to the baseline. Make sure the clock test is administered, also. Google “dementia vs depression”.

Staging of various symptoms one might experience with dementia is just that, staging. Some people follow the staging like it's a script, some experience some symptoms earlier or later than the staging shows, or not at all. What one might experience has much more to do with the underlying cause of the dementia and what part of the brain is impacted. Likely some genetics and personal history impacts how it affects the person too.

Sun-downing can be a symptom of dementia, but can also be caused by other conditions. A thorough checkup, including blood work AND a urine culture should be considered, to rule out any imbalances and/or a UTI. UTIs are notorious for causing dementia-like behaviors, including sun-downing. The only time my mother had sun-downing was during her first UTI while living in MC. Once treated (including anti-anxiety during treatment), no more sun-downing for her. Sometime prior to dementia, she was in a confused state. I took her to the ER and she had been drinking too many non-alcoholic fluids, washing out her system (most elders tend not to drink enough.) Low potassium can result in serious confusion (or worse.) Once on fluids, she returned to her normal self.

The test done in a doc office is generally more of a tool to get a baseline and then watch for changes in subsequent tests. Clearly some can already be beyond capability for taking the test (my mother was already in MC 2 years before anyone tried that test! FAILURE!) The purpose is to test "orientation, attention, memory, language and visual-spatial skills." Many in early stages CAN and DO "pass" the test. Regular PCPs aren't as qualified to really dig deeper. As someone else noted, >24 indicates no cognitive issues, BUT it doesn't assess everything. There can be other cognitive issues. Also, many can "show time", which is basically being able to pull up their socks and *appear* somewhat normal, for short periods of time. In our doc office, the nurse administered the test. Doc only sees patient for maybe 10-15 minutes? Doc doesn't see patients in their normal habitat and are not able to assess all their abilities over a period of time.

I would, in addition to have the blood and urine tests, ask for more in-depth testing or assessment. When I tried to hire aides so mom could stay in her own place longer, they sent a nurse first, with a much better test - all covered by Medicare. It was done in the comfort of mom's place with 2 of us there. I already figured out it was dementia (quick learning online!!!), but this test assessed so much more! If I knew what that test was called, I'd post it here.

Some people are very good with memorizing and recall. I never was that great with just random words or numbers - too much else to worry about than stupid random data! So I do worry they might think I'm failing! I know what needs to be done and how to do it, but just memorizing random crap or even peoples' names - I have to hear the names multiple times AND associate it with something else. I've always been juggling many tasks and hats (single mom, with a house and 2 kids to raise, full time job and even a second part time job for 2 years, going back to school for a second degree, etc. More recently I had to juggle all my duties, help my daughter juggle her finances through my CCs (she paid, but I had to keep track!), all the bills and care/cleaning/repairs for mom's condo until we could sell it AND manage all her finances and medical care while keeping track of supplies and bringing them! Finances included primary account, special Rep Payee account for SS, and a trust fund. I'm not there in dementia land yet!!

So, perhaps a good PCP checkup to rule out any other potential treatable causes AND a referral for additional assessment or testing. If it isn't UTI or infection, there are medications that can take the "edge" off sun-downing. Mom took those during the UTI treatment - worked first time, every time in about 10-15 minutes, didn't "dope" her up.

Like others have suggested, more thorough testing can be helpful if he’ll agree to it. My father was very resistant to testing. He was afraid the doctors would think he was “crazy” and put him in a mental institution. For lots of great info on dementia types, symptoms and care, watch Teepa Snow videos. She also talks about the types of tests that are done, and the fact that the GP test is rather unreliable.

Just watch for uti. Men can get them too. Uti’s can cause confusion too.

Seems your father may have some cognitive impairment but not dementia per se. Confusion has lots of causes: infections (those pesky UTIs), blood chemistry imbalances, poor oxygenation, neurological insults, side effects of medications, inadequate sleep.... The best way of treating the confusion is determining the cause which is the job of the doctor. Since your father has stopped a medication is may take a few weeks to see change. Remember that older body systems do not clear medications as fast from the body as younger systems.

Meanwhile, you can do something about Sundowner's Syndrome. Keep your father on a consistent schedule. Turn on more lights in the afternoon/evenings (shadows tend to be confusing). Have your father's vision checked in case he needs an eyeglass prescription. Make sure he gets enough sleep at night (7-9 hours is about right). Try to make sure your father is getting enough tine interacting with other people since loneliness/social isolation can sometimes be confused with depression.

Hope this helps.

My Dad will be turning 97 next month in May.
He had Dementia and Very Short Term Memory.
I decided not to have him on any drugs as everything has some kind of side effects and I out weighed out the side effects verses the help.
The drugs can make you more confused then you are and they can also make you depressed and suicidal.
Juse realize it's ok at his age to have short term memory and to be confused.
Just assure him he is home when he asks.
Try not to make any changes.
Also, my Dad gets UTI urinary Tract Infections which are common, because he has to have a Cathiter.
When he gets a UTI, he does get more confused and has to be in antibiotics 5 days.
Other thanks that, he only takes a vitamin a day, that's it.
Juse remember what a drug is offered, it will always do something else which makes you have to give another drug for that.
Less Is Better!

Prayers

Sorry to hear what you are going thru, I feel for you.

Both my parents have memory issues and both are in their 80's. My Dad is very well aware that he does not remember things, especially appointnents or even coming to my house for dinner, he needs to write it down in his pocket calendar.

My Mom however, has different memory issues. Can't get her to the doctor, although the one time we did the neorologist thought dementia. She does not believe she has any problems, and always, in her mind, has a reason for why something happened. I'm often the one she blames when she can't find something, I've stolen it.

Does your Dad have a favorite blanket? Or a clock? Something that really means home to him? Thinking if its like an afgan then maybe put it on his favorite chair that he sits in or something.

We really need to keep advocating for our parents, or elderly family. We know them at their best and at their worst keep it up.

Just thinking to, is he drinking enough fluids? Dehydration can be a corncern.

Hope this helps and keep up the good work.

You would be surprised what drugs can do. Sometimes they treat one thing, but cause another. It just that sometimes what medication is for the better good, is a lesser evil. Confusion and dementia are not two different things, but a combination of symptoms. This is why doctors will always ask you, Is the patient at or near their baseline? Unfortunately as Alzheimer’s Disease progresses it will be more difficult for you to determine what may be causing a “problem” and whether or not the baseline is worse, or just a fleeting episode. Sometimes it is just instinct to determine that something is off with your Loved One, and go from there to investigate. Taarna has some good advice. I would add that maybe getting enough sleep at 7-9 hours is too high of an expectation because as we get older we need less sleep. Naps during day probably would be more helpful.

My MIL is nearly 90 years old, and her MMSE has indicated that she has MCI (early dementia). However at times she seems to be perfectly normal, especially around people who are not close family. From what I understand, this phenomenon is known as "show staging". A UTI can also lead to confusion and dementia like symptoms as well, or worsen ones that are already there.

I agree on the UTI - the change in my mothers cognitive status and confusion goes from normal to confusion moments throughout the day when she has a UTI. I would also check electrolytes and suggest bloodwork.
My mom had a stroke so she has small cognitive issues so it did took me awhile to be able to see and learn “yup uti coming on”. Things I thought in the beginning were just age and stroke related were actually UTI many times.
I now keep the at home test strips for when I suspect it - allows me to determine quicker and have a sample sent out by her primary quicker. She has stubborn ones so getting the sample out to see which antibiotic will actually treat it correctly is very important with moms UTIs. Best wishes for answers.

Like another poster said, my mom, who had Alzheimer's, could also appear fine around strangers. She, like your dad, would often ask when she was "going home." I wrote about our travails taking care of her called, "My Mother Has Alzheimer's and My Dog Has Tapeworms: A Caregiver's Tale." I also agree that a UTI can cause confusion. My mom's symptoms included a jumble of everything: confusion, agitation, paranoia, memory issues, etc. For her, less was more in terms of medicine, since she was very sensitive to it. After some tweaking of medication, she was put on 2, and I think they might have kept things at bay for a while, but I've recently read that some of her issues, like hallucinations, can be caused by 1 of those medicines. Everyone's body responds differently. Maybe your dad needs a complete work-up by a geriatric psychologist/psychiatrist and/or a neuropsychologist or neuropsychiatrist. We went to a local neurologist. I didn't know about these sub-specialties until recently, (long after the fact). I've been told that sometimes diseases and their symptoms can overlap. Best of luck.

As several have said, there is good information on this topic online. However, I would say that it's unusual that someone with depression alone will completely forget they are home, or get confused about something that basic. The kind of memory issues that come with depression are more about the thoughts being a bit jumbled, slowed down, and the person forgetting to do things, or not recalling what they've been told because they weren't fully paying attention or registering the information. There can also be notable mood changes with depression, including irritability. With Mild Cognitive Impairment, there is memory loss, with early-stage dementia, there can be more than memory loss: reduced executive functioning - i.e., not being able to follow directions or do more complex tasks - confusion about time and place, and mood/personality changes. So there can be some overlap, but the real confusion issues usually are part of a dementia syndrome. Also, one person can have early-stage dementia and depression or anxiety concurrently. In fact, when people realize they are starting to forget and become confuse, it is often cause for them to become discouraged and anxious, at least temporarily.

I've learned that confusion can also set in from dehydration or UTI/infection.

That sort of confusion is a symptom of dozens of things, and it is not sensible to guess. Take him to a doctor who will check his bloods and check his urine and not just agree with his patient's adult child about what to try next. [Not that I personally have anything to say about statins one way or the other].

A uti ???

also be very watchful about meds as he may not be able to tell you if he feels he is having a problem.

Imho, it could be a variety of illnesses. Suggest blood work and physician appointment.

Yes, my sister did in-home care for an elderly Russian woman who was highly functional and spoke English fluently. Her doctor put her on a statin drug and she began to speak only Russian and believed she was living in St. Petersburg, Russia.
The doctor told the family that their mother had developed severe dementia.
My sister convinced the family to try taking her off of the statin, and within about 2 -3 weeks she was her normal self again.

I think anxiety and depression make dementia symptoms much worse. Before I got my mother (with Alzheimers) on antidepressants she was a mess. She would cry all the time, stumble around, and pee herself. She couldn't focus at all. She is much better now that she is calm.

I was having this conversation with my mother's doctor just the other day. Mum (86) takes statins and also doesn't drink enough, and her mother and brother both got dementia in their late 80s. So for her it could be any of these causes.

She knows where she is but her short-term memory and recall of names are getting worse; the most concerning thing is that she frequently says she 'can't be bothered' to heat up food, to get up and close the window when the sun goes in, etc. This sounds more like depression.

Chart out all his meds. Lots of seniors get overmedicated, especially following hospital stays— where every doctor just adds a new medication or ups a dose on rounds. The unnecessary medications are never eliminated/tapered. The doctors never see the patient again.

After a couple of years of occasional hospital visits my Mom slowly came to be on a lot of “maintenance” medications. She became confused.

I worked with a physician subbing for her doctor when her primary was out of town. The sub agreed she was on too many medications and her dosages were high for someone her size. (Her primary doctor had been reluctant/resistant to this discussion).

Mom’s mental status returned! A visiting nurse shared the results with families of her other patients and told me two of her other patients had been too medicated and were also “rescued.”

This was a miracle!

Agree w/ those who have mentioned UTI. It fascinates me how much the symptoms of a UTI in the elderly present as dementia-type behaviors, at least in the case of my mom this was very true.

And I agree a meds review would also be a good idea. It gets overwhelming trying to look for contraindications and side effects when your loved one is taking a bunch of maintenance meds. Good luck.