Chart — Geriatrics
Delirium vs Dementia vs Depression Chart
The three D’s of geriatric cognition compared across the features that separate them at the bedside — and the reason delirium is treated as a medical emergency while dementia and depression are not.
Data Source: Confusion Assessment Method (CAM) / Geriatric Nursing Standards
Educational use only. Cognitive changes require provider evaluation; never attribute new confusion to age or dementia without a workup. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Feature Comparison
| Feature | Delirium | Dementia | Depression |
|---|---|---|---|
| Onset | Hours to days — abrupt | Months to years — insidious | Weeks to months — often after loss |
| Course | Fluctuates through the day; worse at night (sundowning can overlap) | Slowly progressive decline | Persistent low mood; may be worse in the morning |
| Consciousness | Altered — hyperalert or lethargic | Clear until late disease | Clear |
| Attention | Severely impaired — hallmark finding | Usually intact early | May be reduced by poor effort or concentration |
| Memory | Impaired by inattention | Impaired — recent memory first | Patchy; “I don’t know” answers are common |
| Hallucinations | Common — often visual | Possible in later disease | Rare (only with psychotic features) |
| Reversibility | Usually reversible when the cause is treated | Not reversible; progression can be slowed | Treatable with therapy and medication |
| First nursing move | Search for the cause — infection, medications, hypoxia, retention, pain | Safety, routines, and caregiver support | Screen mood and always assess suicide risk |
Why Delirium Is Always Urgent
It signals an acute medical problem
Delirium is a symptom, not a diagnosis. UTI, pneumonia, hypoxia, hypoglycemia, new medications, urinary retention, fecal impaction, and uncontrolled pain are the classic triggers — find and treat the cause.
CAM in brief
The Confusion Assessment Method flags delirium when there is (1) acute onset and fluctuating course plus (2) inattention, with either (3) disorganized thinking or (4) altered level of consciousness.
Hypoactive delirium is missed most
The quiet, withdrawn patient who “sleeps all day” is just as delirious as the agitated one — and carries a worse prognosis because nobody notices.
NCLEX Pearls
- ✦Acute onset + inattention = think delirium until proven otherwise.
- ✦A UTI presenting as new confusion in an older adult is a classic NCLEX scenario.
- ✦Depression in older adults can mimic dementia (“pseudodementia”) — effort is poor but cueing helps recall.
- ✦Reorientation, sleep protection, glasses and hearing aids, early mobility, and hydration are first-line delirium interventions — not restraints or sedatives.
- ✦New confusion is never “just old age.” Always investigate.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Confusion Assessment Method (CAM) / Geriatric Nursing Standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →