The 3 D’s: Understanding Dementia, Depression, and Delirium

When physiotherapists work with patients and their families, a treatment relationship develops.

This means that a physiotherapist gets to know their patient’s personality, coping strategies, cognitive strengths and challenges. This treatment relationship can be used to set a standard of what’s normal –and what’s not. If you can learn these common types of changes in the 3 D’s: dementia, depression or delirium, then you might be able to help your family member recover faster.

Why is this important?

By the year 2036, one in four Canadians will be over 65(1). It’s likely that one of those Canadians will be a member of your family. Many of these older adults who value healthy aging will look for help from physiotherapy.

Some of them may already be managing a mood disorder or a decline in memory. Physiotherapists keep an eye out for any potential issues and use an adapted approach for these patients. They’ll also try to flag any changes in behavior or personality that might require further assessment through the patient’s primary care provider.


So, what are these 3 Ds?

1. Dementia is a general label for a group of symptoms which can be caused by different illnesses.

Most diseases causing dementia are progressive. They can impact memory, reasoning, communication, along with other symptoms.

More common types of dementia are:

  • Alzheimer’s disease
  • Vascular dementia
  • Mixed dementia (Alzheimer’s disease plus vascular dementia)
  • Frontotemporal dementia
  • Lewy Body dementia.

Memory loss is often considered the key feature of dementia, but there are many other potential symptoms.

These can include:

  • Changes in personality
  • Social engagement
  • Communication
  • Judgement
  • Initiative

Given that the onset and progression are not clear, it takes time to paint the picture of symptoms and to receive a diagnosis.


How physio can help

If your family member is experiencing cognitive change, they may require an adapted approach during their physiotherapy sessions. If there is memory loss, it can be helpful to use written instructions, enlist the support of a caregiver (a family member, a friend or a support worker) or consider using tech devices to remind them. Repetition, routine and any strategies you already use will help.

Communication might also become difficult for individuals with dementia. It’s important not to just rely on one form of communication. Written information may be very helpful as well as verbal instruction or demonstration. Limiting noise in the environment will also help the person to focus.

Another common symptom in dementia is a loss of awareness about changing abilities. The person may not remember what difficulties they now have as a result of dementia. It’s important to avoid challenging the patient or inadvertently correcting their reality. Instead, the best approach may be to repeat what task is at hand and take any ‘blame’ yourself.


2. Depression is a common, yet treatable mental illness.

A patient may have feelings of sadness, hopelessness or a loss of interest in previously enjoyed activities. Feelings of sadness are common for any of us. But for someone who is depressed, these symptoms will have lasted at least two weeks and may be accompanied by other changes like:

  • Trouble with concentration
  • Memory problems
  • Disturbed sleep
  • Excessive tiredness
  • Decreased appetite. (1)

In physiotherapy sessions, the person may not be interested in or fully participating in their recovery. The person may drop out of therapy and never regain their best function. There is also the risk that they are feeling suicidal.  While depression is a treatable illness it is very common for individuals to hide how they are feeling and not seek help.

How physio can help: The physiotherapist may be able to encourage their patient to speak to their primary care provider about how they are feeling. This gives the primary care provider the opportunity to investigate, rule out potential causes and offer treatment.

Encouragement and focusing on successes will help a patient to stay involved in their therapy and to make sure that treatment goals are broken down into achievable steps.


3. Delirium is a condition that can happen to anyone.

However, it’s more likely to happen to someone already living with dementia, depression or other medical conditions. Delirium appears as a sudden change in someone’s abilities. These can include suddenly:

  • Being more confused
  • Being so sleepy that they are difficult to wake
  • Not making sense as they speak

Whenever there is a sudden change in a person’s abilities, it’s important to seek medical attention so that the cause can be determined. The cause could be a variety of causes, like an infection or a reaction to a medication.

The key is to act quickly to figure out the cause so that the person can recover. Once the cause of delirium is understood, then a patient can return to physiotherapy (although they may need some added supervision during their recovery time).

While these 3 D’s all present challenges to a physiotherapy patient, they can all be addressed.

Content provided by

Maureen O’Connell, PT, BHSc(PT)
Psychogeriatric Resource Consultant (PRC)
Collingwood General & Marine Hospital, ON

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  1. MacCourt P., Wilson K., & Tourigny-Rivard M-F. (2011). Guidelines for Comprehensive Mental Health Services for Older Adults in Canada. Calgary, AB: Mental Health Commission of Canada. Retrieved from:
  2. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. Int J Geriatr P s y c h i a t r y 2000; 15(11): 1021–1027.
  3. Montreal Cognitive Assessment (MOCA)
  4. Alzheimer Society of Canada. Rising Tide study
  5. Østbye T1Kristjansson BHill GNewman SCBrouwer RNMcDowell I. Prevalence and predictors of depression in elderly Canadians: The Canadian Study of Health and Aging. Chronic Dis Can. 2005 Fall;26(4):93-9.
  6. Registered Nurses Association of Ontario. Best Practice Guideline for Screening for Delirium, Dementia and Depression in Older Adults –
    1. SIGECAPS – page 75
    2. Confusion Assessment Method – page 72
    3. Cornell – page 76
    4. Geriatric Depression Scale – page 77
    5. Vancouver Island Health Authority. Delirium in the Older Person: A Medical Emergency. Developed 2006; Revised: 8: 2014. Available from:


The Canadian Physiotherapy Association (CPA) represents physiotherapists, physiotherapist assistants and physiotherapist students across Canada. CPA members are rehabilitation professionals dedicated to the health, mobility and fitness of Canadians.

Physiotherapists are primary health care professionals who combine their in-depth knowledge of the body and how it works with specialized hands-on clinical skills to assess, diagnose and treat symptoms of illness, injury or disability.

More than 20,000 registered physiotherapists work in Canada, in private clinics, general and rehabilitation hospitals, community health centres, residential care and assisted-living facilities, home visit agencies, workplaces, and schools.

The CPA presents its educational references as a public service and for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The opinions expressed do not necessarily represent the opinions of the CPA membership.