Pseudodementia

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Pseudodementia
Other namesDepression-related cognitive dysfunction, depressive cognitive disorder, pseudosenility,[1] reversible dementia[2]
SpecialtyPsychiatry

Pseudodementia (otherwise known as depression-related cognitive dysfunction or depressive cognitive disorder) is a condition where mental

Interpersonal therapy
which focuses on identifying ways in which interpersonal relationships contribute to depression.

Presentation

The history of disturbance in pseudodementia is often short and abrupt onset, while dementia is more often insidious. Clinically, people with pseudodementia differ from those with true dementia when their memory is tested. They will often answer that they don't know the answer to a question, and their attention and concentration are often intact. They may appear upset or distressed, and those with true dementia will often give wrong answers, have poor attention and concentration, and appear indifferent or unconcerned. The symptoms of depression oftentimes mimic dementia even though it may be co-occurring.[3]

Causes

Pseudodementia refers to "behavioral changes that resemble those of the progressive degenerative dementias, but which are attributable to so-called functional causes".[4] The main cause is depression.

Diagnosis

Differential diagnosis

The implementation and application of existing collaborative care models, such as DICE, can aid in avoiding misdiagnosis.

Comorbidities (such as vascular, infectious, traumatic, autoimmune, idiopathic, or even becoming malnourished) have the potential to mimic symptoms of dementia.[5] For instance, studies have also shown a relationship between depression and its cognitive effects on everyday functioning and distortions of memory.[6]

Investigations such as

MRI shows medial temporal lobe atrophy in people with AD.[7]

Pseudodementia vs. dementia

Pseudodementia symptoms can appear similar to

social withdrawal are commonly identified as symptoms in the elderly but oftentimes is due to symptoms of depression.[9]
As a result, elderly patients are often misdiagnosed especially when healthcare professionals do not make an accurate assessment.

Older people with predominantly cognitive symptoms such as

neurodegenerative syndrome involving a pervasive impairment of higher cortical functions resulting from widespread brain pathology.[12]

A significant overlap in cognitive and neuropsychological dysfunction in Dementia and pseudodementia patients increases the difficulty in diagnosis. Differences in the severity of impairment and quality of patients' responses can be observed, and a test of antisaccadic movements may be used to differentiate the two, as pseudodementia patients have poorer performance on this test.[2] Individuals with pseudodementia present considerable cognitive deficits, including disorders in learning, memory and psychomotor performance. Substantial evidences from brain imaging such as CT scanning and positron emission tomography (PET) have also revealed abnormalities in brain structure and function.[2]

A comparison between dementia and pseudodementia is shown below.[2]

Variable Pseudodementia Dementia
Onset More precise, usually in terms of days or weeks Subtle
Course Rapid, uneven Slow, worse at night
Past history Depression or mania frequently Uncertain relation
Family history Depression or mania Positive family history for dementia in approximately 50% DAT
Mood Depressed; little or no response to sad or funny situations; behavior and affect inconsistent with degree of cognitive deficit Shallow or labile; normal or exaggerated response to sad or funny situations; consistent with degree of cognitive impairment
Cooperation Poor; little effort to perform well; responds often with "I don't know"; apathetic, emphasizes failure Good; frustrated by inability to do well; response to queries approximate con fabricated or perseverated; emphasizes trivial accomplishment
Memory Highlight memory loss; greater impairment of personality features (e.g. confidence, drive, interests, and attention) Denies or minimizes impairments; greater impairment in cognitive features (recent memory and orientation to time and date)
Mini-Mental State Exam (MMSE).[13] Changeable on repeated tests Stable on repeated tests
Symptoms Increased psychologic symptoms: sadness, anxiety, somatic symptoms Increased neurologic symptoms: dysphasia, dyspraxia, agnosia, incontinence
Computed Tomography (CT) and Electroencephalogram (EEG) Normal for age Abnormal

Treatments

If effective medical treatment for depression is given, this can aid in the distinction between pseudodementia and dementia. Antidepressants have been found to assist in the elimination of cognitive dysfunction associated with depression, whereas cognitive dysfunction associated with true dementia continues along a steady gradient. In cases where antidepressant therapy is not well tolerated, patients can consider electroconvulsive therapy as a possible alternative.[8] However, studies have revealed that patients who displayed cognitive dysfunction related to depression eventually developed dementia later on in their lives.

The development of treatments for dementia has not been as fast as those for depression. Thus far, cholinesterase inhibitors are the most popular drug used to slow the progression of the Alzheimer's disease (most frequent dementia) and improves cognitive function for a period of time.[14]

History

The term was first coined in 1961 by psychiatrist Leslie Kiloh, who noticed patients with cognitive symptoms consistent with dementia who improved with treatment. Reversible causes of true dementia must be excluded.[12] His term was mainly descriptive.[15] The clinical phenomenon, however, was well-known since the late 19th century as melancholic dementia.[16]

Doubts about the classification and features of the syndrome,[17] and the misleading nature of the name, led to proposals that the term be dropped.[18] However, proponents argue that although it is not a defined singular concept with a precise set of symptoms, it is a practical and useful term which has held up well in clinical practice, and also highlights those who may have a treatable condition.[19]

References

  1. S2CID 23256265
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  2. ^ a b c d Nixon, S.J. (1996) Secondary dementias: reversible dementias and pseudomentia in R.L. Adams, O.A. Parsons, J.L. Culbertson & S.J. Nixon (Eds.) Neuropsychology for Clinical Practice: etiology, assessment, and treatment of common neurological disorder. (pp. 107–130). Washington, DC: American Psychological Association
  3. PMID 453349
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  4. ISSN 1931-1559.{{cite journal}}: CS1 maint: multiple names: authors list (link
    )
  5. ^ Kverno, Karan S. and Roseann Velez. “Comorbid Dementia and Depression: The Case for Integrated Care.” Journal for Nurse Practitioners Volume 14, Issue 3, March 2018, Pages 196-201. https://doi.org/10.1016/j.nurpra.2017.12.032
  6. ^ Sjunaite, Karolina, Claudia Lanza, and Matthias W. Riepe. “Everyday false memories in older persons with depressive disorder.” Psychiatry Research 261 (2018): 456-463. https://doi.org/10.1016/j.psychres.2018.01.030
  7. ISBN 0-521-47275-X
    .
  8. ^ a b c Thakur, Mugdha Ekanath. "Pseudodementia." Encyclopedia of Health & Aging, edited by Kyriakos S. Markides, SAGE Reference, 2007, pp. 477-478. Gale Virtual Reference Library. Accessed 5 July 2018. (subscription required)
  9. ^ Venes, Donald. Taber's Cyclopedic Medical Dictionary.Philadelphia: F.A. Davis Company, [2017] Print.
  10. PMID 7316680
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  11. PMID 3955324
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  12. ^
    ISBN 9780199204854
    .
  13. PMID 1202204
    .
  14. ^ Swartout-Corbeil, Deanna M., and Rebecca J. Frey. "Dementia." The Gale Encyclopedia of Nursing and Allied Health, edited by Brigham Narins, 3rd ed., vol. 2, Gale, 2013, pp. 966-976. Gale Virtual Reference Library. Accessed 20 Aug. 2018. (subscription required)
  15. S2CID 221390518
    .
  16. PMID 3889224
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  17. PMID 6342420
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  18. PMID 1288665
    .
  19. ISBN 0-8018-7156-5
    .

Further reading
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