Delirium can be difficult to distinguish from severe depression in elderly patients. Depression is one of the principal emotions of delirium in elderly patients, and the conditions share many clinical features. As a rule, cognitive impairment associated with severe depression is relatively mild in comparison with the affective disturbance, whereas the reverse is true of delirium. The pattern of diurnal variation also varies in the two disorders, with depressed patients tending to be worse in the mornings, and delirious patients in the evenings; however, the 'morning delirium' shown by some patients may cause diagnostic difficulties. It should be borne in mind that elderly depressed patients are at increased risk of delirium, either through self-neglect or because of the antidepressant treatment they are receiving. Anticholinergic tricyclic drugs are particularly troublesome in this respect. Adverse life events, such as bereavement, may precipitate both depression and delirium in vulnerable individuals.

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