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| When treated (as depression), in contrast to true dementia, pseudodementia often responds positively with a parallel improvement in cognition. |
Pseudodementia is depression masquerading as dementia. Depressed elderly patients may exhibit substantial cognitive deficits. To complicate the clinician's task, 20% to 40% of Alzheimer's patients have major depression (Brown, 2005). So, the question is how to differentiate the two.
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.
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. When treated (as depression), in contrast to true dementia, pseudodementia often responds positively with a parallel improvement in cognition.
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.
In summary, psychiatric symptoms as as dementia-like deficits in the elderly result from a host of conditions, many of them readily treatable, if properly recognized. A high index of clinical suspicion is essential.
SOURCE:
Psychological Masquerade:
Ddistinguishing Psychological from Organic Disorders
By Dr. Robert L. Taylor, MD
Published by Springer Publishing Company, 2007
Week of June 7, 2009
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