Friday, May 20

Pseudodementia is Often Curable

Sad senior lady
Pseudodementia walks and talks like dementia, but it often responds positively, with treatment permanently improving cognition. Learn how recognizing the difference can change one's life.

Pseudodementia was first coined in 1961 by psychiatrist Leslie Kiloh. Dr. Kiloh noticed patients with cognitive symptoms consistent with dementia who improved with treatment, a pattern inconsistent with the progressive neurodegenerative nature of dementia.


Pseudodementia can be caused by a large variety of underlying disorders, but most commonly, it is depression masquerading as dementia.

Depressed elderly patients may exhibit substantial cognitive deficits. To further complicate the clinician's task, people with dementia are often depressed. For example, 20% to 40% of Alzheimer's patients have major depression (Brown, 2005). This makes the relationship between depression and dementia very complicated. So the question is how to differentiate the two.

Pseudodementia can sometimes be the result of causes that are “not real” and even “fake”. Pseudodementia can be the result of psychological tension that is not caused by a physical illness. Notwithstanding, it is more likely that it is caused by a real brain pathology.

Telling Depression & Dementia Apart

In contrast to the gradual onset of dementia, pseudodemented depression comes on rapidly. Furthermore, whereas the pseudodemented patient appears distressed and may express fear of losing his mind, the person with true dementia often seems relatively unconcerned and tends to minimize his problem.

Continued below table...
Source: Clinical Concerns

The truly demented patient is usually inattentive and has greater impairment of recent than remote memory. In contrast, the depressed patient, though attentive, will complain of both kinds of memory loss and then test better than what he describes. He is also more likely to have had previous similar episodes.

While a demented person may cooperate and try to bluff his way through the testing, the pseudodemented person is often uncooperative, insisting that he cannot do it. This should not be confused with malingering but seen more as a reflection of the feeling of inadequacy that goes along with serious depression.

Treating Pseudodementia

When treated (as depression), in contrast to true dementia, pseudodementia often responds positively. While the depression may be treatable, treatment rarely achieves a full reversal of the cognitive impairment that made the doctor suspect dementia.

Risk Factors

Unfortunately, recent studies suggest pseudodementia carries an increased risk for the subsequent development of true dementia (Brown, 2005). It may turn out that depression in the elderly, at least in some cases, is an early signal of dementia. Still, if at the initial presentation the problem is mainly depression, it is important that it be recognized and treated accordingly.

Clinical Suspicion is Essential

In summary, psychiatric symptoms that bring on dementia-like deficits in the elderly result from a host of conditions. Many of them are readily treatable, if properly recognized. The term "pseudodementia" provides a "starting" language that offers a useful step in getting to a more accurate diagnosis and treatment. A high index of clinical suspicion is essential.



  1. I'd like to see more information as to how advanced dementia takes over the entire body and is actually a cause of death.

  2. This article comes from an old publication, and its contents are outmoded. The relationships between depression and dementia are very complicated. Research has shown that cognitive deficits associated with depression typically cannot be fully reversed, and often constitute a prodromal feature (early manifestation) of, and/or risk factor for, a neurodegenerative dementia such as Alzheimer's. Moreover, the prevalence of depression is very high in patients who have a neurodegenerative dementia; and the depression symptoms may respond to treatment although the underlying dementia disorder will not.

    The use of the term "pseudodementia" is very controversial. "Pseudodementia" does not actually mimic true dementia; in course of illness, complaints, and cognitive impairment, the two conditions are quite different. Further, the term "pseudodementia" is considered to be politically incorrect. The term "pseudodementia" literally means false or pretended mental disorder; it implies that the dementia is not real or, even more offensively incorrect, that it is faked. Depression is associated with all sorts of biologic changes, from pituitary-adrenal overactivity, to decreased serotonin receptor activity, to shifts in hippocampal size and prefrontal cortex activity; so even if the cognitive impairment associated with depression responds -- at least, to some extent -- to treatment, it is still associated with "organic" brain pathology.

    At best, the term is now considered useful only in fostering awareness of potentially treatable psychiatric symptoms, even in cases of progressive dementia.

    1. Thanks for the comments. You make a lot of good points, so I'll respond to them one at a time.

      1. After you posted the comments above, the article was appropriately updated.
      2. Emphasis was added on the complicated relationship between depression and dementia.
      3. It was noted that depression treatment rarely fully reverses cognitive impairment.
      4. Regarding mimicking, a table was added to this article to help tell depression and dementia apart. This was done to help make it clear that a sophisticated diagnosis can easily tell true dementia apart from pseudodementia.
      5. As for political correctness, our readers need competent language and clear information. Though not a happy thought, pseudodementia can be the result of causes that are “not real” and even “fake”. It is more likely that, as you point out, it is caused by real “organic” brain pathology. The article was edited to drive your point home.
      6. Even if the usefulness of the term “pseudodementia” is limited to awareness, that still means it is useful and important to offer as a reference on Alzheimer’s & Dementia Weekly. The points you made here substantially add to the usefulness of this information and are very much appreciated.

      Thank you.

    2. You are doing a great disservice to people in the early stages of Alzheimer's to suggest that some dementia is "not real and even fake." It does not belong in an article discussing depression and dementia because depression with dementia is a huge problem, and the fact that a very tiny, tiny number are faking for one reason or another is irrelevant to the actual problems of depression-caused dementia. In fact, the fakers do not have pseudodementia. (I am aware of a case in which a man faked dementia to get disability payments.) They are just faking. The term "pseudodementia" is losing favor quickly, and rightly so.

  3. This is a very interesting article! From my own experience I have found that memories can be stimulated and even reborn for a person with Alz/Vascular type dementia, even in the later stages and there is a definite cross over with depression which in my mother's case has been alleviated with social interaction, CST, memory cafes and a great deal of singing together! So then I have to say I agree with the "fostering awareness of potentially treatable symptoms" even in the later stages of progressive dementia! These effects are not permanent and some results last only a few weeks or months, so the interaction must continue as long as possible to support the person with dementia and alleviate depression as much as possible. As each person is different it must be very complicated for GPs to comprehend how well this kind of treatment is working but it sure does!

  4. My 35 year old daughter has recently been diagnosed with pseudodementia. I am at a loss as how best to support her as her social worker (who offers no practical support) has told her she must start looking after her children without support from me; I currently look after the children 4 evenings a week at my daughters request. Surely she needs support more than ever?


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