Differential Diagnosis Of Dementia vs.
Depression
Symptom Dementia
Onset and Slow and insidious onset; deterioration
duration is progressive over time.
Course Symptoms are progressive over a long
period of time; not reversible.
Alertness Generally normal
Attention Generally normal
Perception Misperceptions usually absent (can be
present in Lewy body dementia)
General Frequent lack of concern or denial
response to about symptoms.
cognitive and
functional
decline
Mood Normal most of the time.
Unhappiness is reactive to
circumstances and fluctuates.
Labile, especially with vascular
dementia. Mood often brightens
with stimulation and support.
Interest, Gradual loss of interest and initiative
initiative (apathy) over a longer period of time
(years rather than weeks). Not
accompanied by statements of
sadness, tearfulness, or other distress.
Still enjoys activities in a structured
environment.
Eating behavior Gradual loss of weight (over months
and weight to years) which is common in
dementia. Large increases in weight
may be secondary to decreased
activity, medications, and hyperorality
in patients with frontal behavioral
presentations (more common in
frontotemporal dementia like Pick’s
Depression
Recent change in mood
persisting for at least two
weeks – may coincide with
life changes – can last for
months or years.
Typically worse in the
morning. Usually reversible
with treatment
Normal
May appear impaired
Usually intact
(hallucinations and
delusions only present
in severe cases)
Amplification of and
excessive preoccupation
with deficits.
Subacute (weeks) onset of
pervasively sad mood, most
of the day and nearly every
day. Doesn’t brighten much
with stimulation.
Subacute loss of interest and
pleasure over a few weeks,
frequently accompanied by
sad mood and affect, and
occasionally statements of
guilt, hopelessness and self-
harm.
Subacute changes (weeks)
in appetite leading to
increase or decrease
in weight.
 Disease).
Sleep Gradual disruption of the sleep-wake Sub acute changes in sleep
cycle (over months to years) due to over a few weeks (increase
brain changes of dementia, resulting or decrease).
in frequent night-time wakening and
daytime sleeping.
Psychomotor Gradual (months to years) increase in Subacute (weeks) onset,
agitation agitation, generally worse during the often worse in the
latter part of the day (sundowning). morning, may be present
Patient much worse in unfamiliar persistently throughout
settings (catastrophic reaction), and the day.
often seeking people or places from Generally accompanied by
earlier life experiences. other depressive symptoms
such as nihilistic statements
or excessive guilt.
Psychomotor Seen infrequently in mild to Subacute onset of
retardation moderate dementia, but psychomotor
occasionally in very advanced retardation (over
dementia, and may be mimicked by weeks) in severe
Parkinson’s dementia (facial depression.
masking, slow motor functioning)
or advanced Pick’s Disease.
Energy Generally a normal energy level, Subacute decrease in energy
but reduced activity due to poor and increased complaints of
initiation related to decreased fatigue.
executive functioning.
Guilt or Uncommon, although transient Common in severe
worthlessness statements of worthlessness might be depression, usually
seen in times of stress in those with accompanied with low
preserved awareness of their own mood as well as changes
decline. in appetite and sleep.
Concentrat Concentration is normal in early Subacute loss of
ion and dementia, but impaired in late concentration and sustained
thinking dementia. Thinking ability declines focus. Often indecisive and
throughout the course of dementia. concerned about making
mistakes.
Suicidal Uncommon. Common.
thoughts
and
actions

Difference Of Delirium vs Dementia

Feature Dementia Delirium
Onset and Slow and insidious onset; Sudden onset – over hours or days;
duration deterioration is progressive duration – hours to less than one month,
over time. but can be longer.

Course Symptoms are progressive Short and fluctuating; often worse at night
over a long period of time; and on waking. Usually reversible with
not reversible. treatment of the underlying condition.

Orientation May be normal usually Fluctuates but will always be impaired, in

impaired for time and space some aspect :time, space and person.

Memory Impaired reason and Recent memory

sometimes remote memory

Psychomotor Wandering/exit seeking Hyperactive delirium: agitation,

activity restlessness, hallucinations
Agitated
Hypoactive delirium: sleepy, slow-moving
Withdrawn (may be related to
coexisting depression) Mixed: alternating features of the above.

Alertness Generally normal Fluctuates, may be hyper-vigilant through

to very lethargic.

Attention Generally normal Impaired or fluctuates, difficulty following

conversation.

Mood Depression may be present in Fluctuating emotions – for example:

early dementia anger, tearful outbursts, fear

Thinking Difficulty with word-finding Disorganised, distorted, fragmented

and abstraction

perception Misperceptions usually Distorted – illusions, hallucinations,

absent (can be present in delusions; difficulty distinguishing
Lewy body dementia) between reality and misperceptions