This case, which began as a seemingly straightforward case of progressive dementia, demonstrates the influence of multiple comorbidities (depression and delirium) that are integral to dementia care. As Mrs. Walker experienced significant loss ( her best friend) and stress ( her husband's illness and daughter's divorce), she became depressed. It is interesting to note that along with Mrs. Walker's overt vegetative symptoms of depression (e.g., not eating, losing weight, not bathing), she was also reporting mood problems as indicated in her statement "I'm not worth a damn." In addition to the anti-depressant medication, there was some implicit behavioral treatment as well. Mrs. Walker began socializing more at the senior center and was likely engaging again in more day-to-day pleasant events than she had been before depression treatment. This, in addition to a focus on increasing her functional activity, would be psychological complements to the medication treatment. In addition, perhaps her husband was beginning to experience increased caregiver burden and/or depression himself. Teaching caregivers to increase pleasant events with their care recipients can also help the care-giver's depression. The onset of delirium, by virtue of a urinary tract infection, reflects the dramatic impact delirium can have on persons with dementia. Mrs. Walker became acutely psychotic, agitated, and aggressive. The attending psychiatrist did not simply accept these symptoms as inevitable outcomes of dementia, but evaluated Mrs. Walker for possible contributors to this dramatic decline in social functioning. Delirium is one of the most common comorbidities in dementia care but continues to be one of the most underrecognized.
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