An Overview of Pseudodementia

A look at the relationship between dementia and depression

Depression, Pseudodementia or Dementia?
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Pseudodementia is a term—not an official diagnosis— that is sometimes used to describe symptoms that resemble dementia but are actually due to other conditions, most commonly depression. Thus, depressive pseudodementia has symptoms of dementia but, unlike true dementia, these symptoms may be reversible with treatment for depression.

In rare cases, pseudodementia has been identified as a possibility in schizophrenia, mania, dissociative disorders, Ganser syndrome, conversion reaction, and psychoactive drugs

History

Though the term was being used prior, it wasn’t until psychiatrist Leslie Kiloh published the paper “Pseudo-dementia” in 1961 that others were given the impetus to try reversing cognitive impairments that may have been due to other psychiatric disorders, such as depression.

More specifically, Kiloh's paper, published in the scientific journal Acta Psychiatrica Scandinavica, presented vignettes of 10 patients, most of whom were expressing depressive features. What this did was open a whole area of research and scientific study that examined whether cognitive deficits in cases of depression could be reversed and whether there are underlying causes of dementia. 

Symptoms

Pseudodementia can be thought of as cognitive impairment that looks like dementia but is actually due to depression. Common symptoms of pseudodementia sound a lot like dementia symptoms and include memory loss and impaired executive functioning. Executive functioning impacts the ability to make decisions, as well as plan and organize ideas.

Pseudodementia vs. Dementia

While pseudodementia is not included in the Diagnostic and Statistical Manual-5, it may still be valuable to try to differentiate it from dementia. One study noted that people who were experiencing the cognitive deficits of pseudodementia had the following characteristics:

  • They displayed equal memory loss for recent and past events where typically, short-term memory loss would be the more common early stage dementia symptom.
  • Their memory loss was described as "patchy" and specific.
  • They frequently answered that they “didn’t know” when asked questions.
  • Their cognitive ability varied significantly when given different neuropsychological tasks that were of about the same level of difficulty.

Though others have made this list more clinically specific, the above has been a good benchmark to start.

Could You Have Both?

Older adults are at an increased risk for experiencing dementia and depression. To complicate things, they can also experience the combination of dementia and depression. This challenge may be one reason why there have been reports of high rates of both false-positive and false-negative errors in the diagnosis of dementia.

So, how do you tell the difference between depression and dementia? One important factor is that people with depression might complain about their memory, but they often do reasonably well on mental status exams and other tests that evaluate cognitive function.

On the other hand, those with dementia often deny any memory problems but don't do as well on cognitive tests. Also, a depressed person is less likely to show severe mood swings, whereas someone with dementia shows a wider range of emotions and sometimes makes inappropriate emotional responses (e.g., laughing while others are sad).

Screening and Diagnosis

There are many different opinions out there about the idea of pseudodementia. Some clinicians use this term regularly and describe seeing multiple patients who were incorrectly diagnosed with dementia and whose cognitive functioning later improved with treatment for their depression.

However, other physicians question this idea of pseudodementia and refer to cases where memory loss that might have been initially blamed on depression progressed to true dementia. Their perspective is that the cognitive impairment, along with the signs of depression, were merely early signs of the individual's dementia.

The Geriatric Depression Scale (GDS) is a screening instrument used to detect depression among older adults. The GDS should be one of several methods used in an evaluation.

Older adults might have depression that looks like Alzheimer's or they might have both depression and Alzheimer's or another dementia. If depression is detected, it can be treated alongside other disorders, such as Alzheimer's disease.

The Cornell Scale for Depression in Dementia is another helpful screening test to use since it helps identify if both depression and dementia are present.

Treatment

The idea of pseudodementia is that the cause of the memory loss, for example, is untreated depression. Treatment of pseudodementia, therefore, would essentially be the same as treatment for depression, such as an antidepressant medication.

A Word From Verywell

Whether you agree or disagree with the use of the term pseudodementia, it has become an important idea to consider in the care and treatment of older adults. The timely recognition of depression, dementia and depression in dementia, can help improve quality of life and life functioning for older adults.

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