Pseudodementia

Pseudodementia is a type of cognitive impairment that mimics dementia but actually occurs due to the presence of a mood-related mental health concern, most often depression. This condition is typically seen in older individuals.

Understanding Pseudodementia

The term pseudodementia became widely used following Leslie Kiloh’s 1961 paper, which described cases of people in treatment who experienced cognitive deficits similar to those seen in people with dementia. The cognitive decline experienced in these cases was actually due to mental health conditions rather than those of the central nervous system. Kiloh pointed out the potential reversibility of cognitive impairment in many of these cases, making the paper significant at a time when dementia was considered a condition that could not be reversed.

Some professionals and experts in the field argue against the use of this term, because it is does not offer clear, objective criteria for diagnosis and because the prefix “pseudo-” may lead to the incorrect assumption that the dementia is not real. However, the term pseudodementia is still considered to be useful in reference to cognitive decline that results specifically from depression and other mental health issues, especially in the development of treatment plans.

Distinguishing between Dementia and Pseudodementia

It may be difficult for medical providers to differentiate between dementia and pseudodementia, partially because there is significant overlap between the symptoms of each condition and partially because some other forms of dementia, such as Alzheimer’s disease and Parkinson’s disease dementia, also involve mood symptoms similar to those that characterize depression.

Correctly identifying the condition is an essential aspect of treatment, as treatment for pseudodementia, which may be reversible, differs from treatment approaches designed for other types of dementia, which are generally progressive and often not able to be reversed. Incorrectly diagnosing pseudodementia as dementia may also lead to unnecessary neurological tests and procedures.

People who have pseudodementia are more likely to be aware of and upset by memory issues, while those with dementia may deny having any memory issues and/or minimize the importance of them.The types of specific memory impairments experienced, and an individual’s response to these difficulties, can help differentiate between dementia and pseudodementia. People who have pseudodementia are more likely to be aware of and upset by any trouble they have remembering things, while those with dementia may deny having memory issues and/or minimize the importance of them. Individuals with dementia typically do not perform well on neuropsychological memory tests, while those with pseudodementia often show significantly less impairment on tasks involving memory, even when they doexperience memory difficulties.

The Geriatric Depression Scale (GDS) is one measure used to differentiate between the two conditions, and it is generally the most useful when it is paired with information about an individual’s history and current functioning. On the GDS, individuals with dementia may show a wider range of emotions and may also display emotions that are not congruent with the situation—laughing during a somber event, such as a memorial, for example.

Signs, Symptoms, and Risk Factors

Pseudodementia typically involves three cognitive components: memory issues, deficits in executive functioning, and deficits in speech and language. Specific cognitive symptoms might include trouble recalling words or remembering things in general, decreased attention and concentration, difficulty completing tasks or making decisions, decreased speed and fluency of speech, and impaired processing speed. People with pseudodementia are typically very distressed about the cognitive impairment they experience.

Individuals with pseudodementia might experience symptoms such as delayed motor response, anxiety, and feelings of helplessness and hopelessness. They may be more likely to wake early and be unable to sleep, and they are also likely to experience other symptoms of depression. These symptoms may include:

• A low, depressed mood
• Fatigue or decreased energy
• Insomnia or hypersomnia (excessive sleeping)
• Loss of interest in activities
• Overeating or loss of appetite
• Thoughts of suicide

The risk factors for pseudodementia are much the same as those for depression. Among them are gender (women are  statistically more likely to develop depression), family history, divorce, and lower socioeconomic status. People of all ages can develop depression, but pseudodementia is usually seen in adults in middle age or older. Some researchers have suggested that pseudodementia may occur when a mood-related condition develops in a brain that is already somewhat compromised due to advanced age.

Treatment for Pseudodementia

Treatment for pseudodementia overlaps with the treatment for depression, and symptoms usually improve if depression is successfully addressed and a person’s mood lifts. In many cases, cognitive functioning may be regained completely. Treatment for pseudodementia may include therapy, medication such as antidepressants, or a combination of the two.

Cognitive behavioral therapy and interpersonal therapy are two specific treatments that have been found to be effective for the treatment of depression, and these treatments may also be beneficial in the treatment of pseudodementia. Cognitive behavioral therapy (CBT) involves exploring and changing thought patterns and behaviors in order to improve one’s mood. Interpersonal therapy focuses on the exploration of an individual’s relationships and identifying any ways in which they may be contributing to feelings of depression.

References:

1. Bajulaiye, R., & Alexopoulos, G. S. (1994). Pseudodementia in geriatric depression. In E. Chiu & D. Ames (Eds.), Functional Psychiatric Disorders of the Elderly (pp. 126-141). Cambridge: Cambridge University Press.
2. Brown, W. A. (2005). Pseudodementia: Issues in diagnosis. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/dementia/pseudodementia-issues-diagnosis
3. Iliades, C. (2014). Facts about depression: Who’s at risk? Retrieved from http://www.everydayhealth.com/depression/facts-about-depression-whos-at-risk.aspx
4. Kang, H., Zhao, F., You, L. Giorgetta, C., Venkatesh, D., Sarkhel, S., & Prakash, R. (2014). Pseudo-dementia: A neuropsychological review. Annals of Indian Academy of Neurology, 17(2), 147-154. Retrieved from http://www.psychiatrictimes.com/dementia/pseudodementia-issues-diagnosis
5. Kennedy, J. (2015). Depressive pseudodementia – how ‘pseudo’ is it really? Old Age Psychiatrist
6. Snowdon, J. (2011). Pseudodementia, a term for its time: The impact of Leslie Kiloh’s 1961 paper. Australas Psychiatry, 19(5). 391-397. doi: 10.3109/10398562.2011.610105.
7. Steckl, C. (2008). Reversible cognitive disorder – Pseudodementia. Retrieved from https://www.mentalhelp.net/articles/reversible-cognitive-disorder-pseudodementia
8. Symptoms of depression. (n.d.). Retrieved from http://www.webmd.com/depression/guide/detecting-depression

Last Updated: 10-12-2016