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Pseudodementia - Causes, Symptoms, Diagnosis, and Treatment

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Pseudodementia is a condition that resembles dementia but is not caused by neurological degeneration. Read to know more.

Medically reviewed by

Dr. Abhishek Juneja

Published At May 10, 2023
Reviewed AtSeptember 4, 2023

What Is Pseudodementia?

The psychiatrist Leslie Kiloh published the paper "Pseudo-dementia" in 1961, and others were inspired to try reversing cognitive impairments caused by other psychiatric disorders, such as depression. Pseudodementia can be identified as a possibility in schizophrenia, psychoactive drugs, conversion reaction, dissociative disorders, and Ganser syndrome. The symptoms of pseudodementia frequently resemble mood-related conditions such as depression; some people refer to this condition as depressive pseudodementia.

The following are the primary symptoms of pseudodementia:

  • Difficulties with speech and language lapses or memory loss, difficulty paying attention, and regulating emotions.

  • Organizing or planning difficulties.

These symptoms are very common in dementia patients. As a result, a doctor may diagnose and treat these individuals as if they have dementia. However, pseudodementia is frequently associated with depression; the individual may also experience the following symptoms:

  • Loss of appetite or overeating.

  • General fatigue.

  • Hypersomnia or insomnia.

  • Suicidal thoughts.

  • Social withdrawal.

  • Depression.

  • Loss of interest in daily activities.

What Are the Causes of Pseudodementia?

Depression is a common mood disorder associated with pseudodementia because it can cause cognitive impairment. However, experts emphasize the difficulty in determining a final diagnosis in patients with depression and cognitive deficits. As a result, these experts may refer to a person who has a functional impairment or an organic disorder, but the majority of the patients have components of both.

The causes of pseudodementia include:

  • Stress and depression disrupt the hypothalamic-pituitary axis, resulting in cognitive impairment.

  • Psychosocial and environmental factors such as both mental and physical abuse.

  • Poor social support.

  • Unemployment.

  • Negative life events.

  • Issues in a neurological pathway involving the amygdala and its association with the temporal and frontal lobes.

  • Neuroendocrine factors that have hippocampus neurodegeneration lead to cognitive impairment.

  • In patients with depressive cognitive disorders, genetic factors with repeats on chromosome 9 (C9ORF72) were found.

What Are the Symptoms of Pseudodementia?

Pseudodementia symptoms include a depressed mood, memory impairment, and difficulty concentrating. One difference between pseudodementia and dementia patients is that those suffering from pseudodementia may be aware of the cognitive impairments that they are experiencing. Dementia patients, on the other hand, do not always recognize symptoms or deny the severity of their deficits. The common symptoms observed in pseudodementia patients include

  • Depressed mood.

  • Memory impairment.

  • Social isolation.

  • Loss of energy.

  • Decreased psychomotor function.

  • Difficulty in making decisions.

  • Inability to focus and concentrate.

  • Feelings of worthlessness.

  • Problems with speech and language.

What Is the Difference Between Pseudodementia and Dementia?

There are several parameters that can help differentiate pseudodementia and dementia, including the fact that pseudodementia and depression are potentially reversible, whereas dementia is more difficult to treat, depending on the progression and stage. People suffering from depression may complain about memory problems and appear upset, but neuropsychological memory tests usually reveal no deficits. Individuals with dementia frequently deny having memory problems, despite showing impairment on neuropsychological tests. People with dementia may be unaware of or deny memory problems but perform poorly on cognitive tests. Patients with depression and cognitive impairments perform better on cognitive tests and are more aware of memory problems.

Tests such as the self-reported geriatric depression scale (GDS) can help distinguish between dementia and pseudodementia (PDEM). The GDS scale results help get information about the person's history and current functioning to help with the diagnosis. People with pseudodementia, for example, usually do not have any history of mood swings and are more likely to score high on the GDS. Dementia patients exhibit a wide range of emotions.

How Is Pseudodementia Diagnosed?

Pseudodementia is not a diagnosis but a symptom. Depression and dementia can coexist, but pseudodementia does not impair brain function in the same way that dementia does. Pseudodementia patients may or may not have a history of depressive or vegetative symptoms. They easily give up when their mental status is examined and claim they cannot perform a task without trying. Formal testing indicates that depressed patients outperform genuinely demented patients on declarative memory tests, but this difference may be difficult to discern. Instruments like the Geriatric Depression Scale (GDS) may be helpful.

What Is the Treatment for Pseudodementia?

The two most common types of therapy are interpersonal and cognitive behavioral therapy (CBT). The caregivers should take part in therapy with patients with cognitive deficits and memory. Their observations can then be shared with a mental health professional, who can incorporate them into a treatment plan. Understanding pseudodementia is an effective way to intervene, support, and relate, which is a key component to successful treatment.

  • Interpersonal Therapy - Interpersonal therapy is concerned with the patient's interactions with family, friends, and others. It also investigates how patients perceive themselves.

  • Cognitive Behavioral Therapy - Cognitive behavioral therapy teaches patients to become more aware of negative thought patterns and to change problematic behaviors. The therapists teach patients and caregivers coping strategies and techniques in order to create a more positive environment.

  • Reminiscence Therapy - Reminiscence therapy may be beneficial to those suffering from memory loss. It enables clients to recall memories from their past using all of their senses.

  • Medications - It is a class of antidepressants known as (SSRI) selective serotonin reuptake inhibitors and is the most commonly used depression medication. These are usually the first-line treatments for depression in dementia patients. SSRIs include Fluoxetine (Prozac), Citalopram (Cipramil), and Escitalopram.

Conclusion

Patients must be carefully screened because distinguishing between pseudodementia and a mood disorder can be difficult. If a patient is diagnosed with pseudodementia, the prognosis is good because treatment options are available, and it is reversible when the underlying trigger is treated. Seniors may be more vulnerable as mood disorders are more common in aging brains.

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Dr. Abhishek Juneja
Dr. Abhishek Juneja

Neurology

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