Introduction
Dementia is not a disease. Rather it is a condition that affects memory, thinking, and other social abilities that can interfere with day-to-today activities and affect the quality of life. Even though dementia causes memory loss, it is not the only cause. Multiple other reasons can result in memory loss. Dementia can typically occur when there is damage to the connections of the nerve cells to the brain or when there is loss or death of nerve cells. This happens due to head injuries, brain tumors, stroke, and other causes. In 1961, the term pseudodementia (PDEM) was introduced by Kiloh to explain cases that closely imitated the picture of dementia. The term has been used to explain the cognitive profile of various psychiatric conditions, especially depression in old age, which present with cognitive decline in dementia. Clinically, PDEM has become interchangeable with cognitive deficit patients with major depressive illness. As the term suggests, the clinical condition presents with the picture of full-blown dementia but is a different entity.
What Is Dementia?
Dementia is considered a major neurocognitive condition, which means there is decreased mental function due to medical diseases other than psychiatric illness. It is characterized by a decline in multiple cognitive abilities, such as learning, thinking, reasoning, problem-solving, and decision-making capability, which is acquired rather than developmental. Dementia is most commonly observed in elderly individuals. Therefore, age progression is a risk factor for dementia. In addition, comorbidity can further lead to the condition.
What Is Pseudodementia?
Pseudodementia is a group of symptoms that mimic those of dementia. However, it typically has other underlying reasons, such as depression. Therefore, the symptoms require a complete evaluation to diagnose and treat them appropriately. Treating any underlying issues leading to pseudodementia may also reduce the symptoms. In addition, long-term treatment and lifestyle modifications may give a person the best results. Pseudodementia is a condition that seems similar to dementia but does not have its origin in neurological degeneration. Some people call the condition depressive pseudodementia, as the symptoms often arise from mood-related illnesses such as depression.
The symptoms of pseudodementia are mentioned below:
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Low mood and sadness, which is persistent and permeates all other mood states.
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Loss of interest in earlier activities of interest.
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Easy fatigability, loss of energy, and persistent tiredness.
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A decreased attention span, loss of concentration, and inability to focus on daily tasks.
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A lowering of confidence and self-esteem.
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Having thoughts that the coming future is dark and bleak.
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Feeling worthless and loss of all hope.
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Having guilt-ridden thoughts.
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Having thoughts regarding dying and killing oneself.
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Disturbance in the sleep cycle, such as falling asleep, maintaining sleep, or getting up a few hours before the normal waking time.
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Loss of emotional reactivity as per social requirements.
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Rapid decrease or increase in weight.
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Loss of sexual desires.
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Worsening of symptoms in the morning.
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Decreased activity levels.
Pseudodementia Versus Dementia
The importance of differentiating primary dementing processes from functional illnesses has been emphasized multiple times since Kiloh coined this term in 1961. In his words, such patients "may be in danger of therapeutic neglect and perhaps unnecessary neurosurgical examinations." However, he also mentioned that this term has no nosological significance and only describes a condition. We know that this situation is far more essential for establishing a diagnosis. The timely diagnosis and treatment of depression in the elderly are thus essential to prevent the patient from the effects of progressing depression. It also prevents them from unnecessary evaluations for dementia. The difficulty in diagnosing PDEM and pervasive developmental disorder (PDD) is particularly evident in elderly patients compared to young adults because of the additional mess created by age-related cognitive deficits. No surprise there has been information on high rates of false-positive and false-negative errors in the diagnosis of dementia. This points to the necessity of enhanced clinical diagnostic techniques. Along with this normal age-related cognitive drop, multiple health problems and the everyday use of several different medicines are often the additional factors obfuscating appropriate diagnosis of depression in older people.
Elderly patients are at a greater risk of developing disorders and other medical comorbidities that add to cognitive and mood-related changes. It is challenging to differentiate and diagnose these two disorders. The following are the different ways used to distinguish between the two.
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Determining a patient's baseline ability to function and perform activities of daily living (ADLs) like bathing, walking, using a chair, dressing up, eating, using a toilet, and instrumental activities of daily living (IADLs) like managing finances, grocery shopping, cooking food, using a telephone. This baseline will help the physician notice any changes and act upon them.
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Observing the patient very carefully and enquiring about the patient from his friend, family, or staff from assisted facilities where the patient resides will help in telling us about their cognitive and functional behavior, which might otherwise be missed.
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Patients suffering from depression are more likely to bring their problems to their doctor's attention, whereas patients with dementia might be unaware of them. In addition, certain patients should be screened for pseudodementia, where patients suffer cognitive impairment along with depression.
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Early stages of dementia can easily be neglected as they correspond to the signs of aging. Still, clinical signs to diagnose dementia a doctor would be missed appointments, inability to follow given instructions, poor hygiene, and grooming.
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Depression and pseudodementia can be diagnosed as a more chronic low-mood state with or without cognitive impairment.
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The onset duration for depression is weeks to months, whereas, for dementia, it is months to years.
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The patient's mood is always low in depression and fluctuates in dementia.
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Depression is chronic and responds to treatment, but dementia is chronic and deteriorates over time.
Conclusion
Various studies show that depression is more commonly seen in patients with dementia than in those who do not have this condition. Depressive states adversely affect cognitive functions, especially in old-age or geriatric depression. The differentiation between depression and the early stages of dementia seems to be important. Properly designed studies are needed to generalize these conclusions.
