A Caucasian female octogenarian with multiple medical problems was admitted to the inpatient geriatric psychiatry unit with intermittent altered mental status and decline in memory. She had been hospitalized four times in the previous three months. She was admitted on more than 10 medications and received more than 20 different medications in this time period. It was determined that she had
delirium concurrent with
dementia and/or depression. During her
hospital stay a
urinary tract infection (UTI) was treated, her
anticholinergic medications were minimized, and her
digoxin dose was adjusted. As her mental status cleared, a workup was completed to differentiate between
dementia and depression. She was initially treated with
memantine, but as time progressed it became more evident she was experiencing depression and a "
pseudodementia," which was treated with
sertraline. Her Mini-Mental State Examination returned to 29/30 (her score previously was 26/29). This case demonstrates the complexity of treating an elder individual and the importance of differentiating among
delirium, depression, and
dementia. The pharmacy team played an active role in
medication reconciliation. Additionally, they worked with the medical team to minimize her potentially harmful medications and optimize the treatment of her UTI and depression.