With the extensive and varied dissemination of scientific information that is currently in the media, and with the existing social awareness towards those over 65 years of age in general, and dementia as a disease of this group in particular, the public has begun to shuffle terms such as "Alzheimer's", "cognitive impairment", and "dementia".
As a consequence, more and more people come to our consultations wanting to know if they “should see a neurologist”, because “they are losing their minds” or “they have a fatal memory”. In a large number of these people, their apparent memory problems are actually a failure in attention and / or difficulty in concentration., symptoms both of your depressive or anxious states, and not dementia.
Similarly, there are people who present a much more serious clinical picture of symptoms, with significant memory lapses and confusion that could indicate cognitive impairment, but when examining them it turns out that what causes this symptomatology is an underlying depression and not the organic deterioration of the brain, as is the case with dementia.
On these occasions we talk about Pseudodementia. Pseudodementia can also occur in other functional psychopathological conditions, but the most frequent is depression and we will continue to refer to that here..
Pseudodementia is a type of cognitive impairment that mimics dementia but what happens due to the presence of a mood disorder, depression being the most common. It usually appears in older people.
The term began to be used for the first time after a work by Leslie Kiloh in 1961 on people who presented with symptoms that resembled these of dementia, but were caused by mood disorders. What attracted the most attention was the possibility of reversing cognitive decline when treating depression, something that cannot be done in the case of dementias.
There are professionals and experts who do not agree with the use of this term, since the prefix "pseudo" implies that the symptoms are not real, when in reality there are cognitive problems, only that of a different etiology than in dementia. Even so, "pseudodementia" is still today the usual term to refer to this type of pathology.
Pseudodementia typically includes three types of cognitive symptoms: memory problems, deficits in executive functioning and deficits in speech and language. More specifically, cognitive symptoms can include difficulty remembering certain words or things in general, decreased attention and concentration, and slowed cognitive processing. People with pseudodementia are usually very concerned about the cognitive problems they experience.
People with pseudodementia may also have symptoms of depression:delayed motor reaction, anxiety, and feelings of hopelessness. They tend to wake up early and not be able to go back to sleep, in addition to having low spirits, fatigue or low energy, loss of interest in activities, eating too much or losing their appetite, and self-injurious ideation.
The risk factor's for pseudodementia they are the same as for depression: statistically women are more likely to suffer depression, family history, divorce, and a low socio-economic level. People of all ages can have depression, but pseudodementia is seen more from middle age.
The differential diagnosis between dementia and pseudodementia is not always easy, partly because of the number of common symptoms in the two conditions and partly because other types of dementia such as Alzheimer's or Parkinson's also produce mood symptoms similar to those of depression..
It is very important to correctly identify the patient's clinical condition, since the treatment is very different in the two cases..
There are some important differences between the two conditions that help the practitioner distinguish between them:
Onset of symptoms: in Pseudodementia the onset of symptoms is well defined and is usually rapid, while in Dementia the symptoms appear progressively and slowly.
Illness awareness: In Pseudodementia, patients have a marked awareness of the disease and recognize its limitations, in addition to experiencing them with great anguish. On the other hand, in Dementia there is no awareness of the disease and they do not recognize its limitations.
Humor: Patients with Pseudodementia, being so aware of their symptoms and their limitations, are usually sad and very worried in a general and persistent way, while those with Dementia have a variable mood that is often inappropriate, such as laughing in a sober situation.
Attention and Memory: In patients with Pseudodementia, attention is usually not affected while in those with Dementia it is. In Pseudodementia, Short Term Memory (MCP) is only sometimes affected and Long Term Memory (MLP) is randomly altered. On the other hand, in Dementia, the MCP is always affected, while the MLP is affected progressively and slowly..
Behavior and social deterioration: In Pseudodementia, the behavior is consistent with the deficit and is usually abandonment, while social deterioration appears early. In people with Dementia, the behavior is not consistent with the deficit, patients deny that something is happening and often resort to compensation, pretending they have done something on purpose or conniving an explanation. Social decline is usually slower.
Collaboration with medical tests: According to the awareness of the disease and the usual mood of each condition, in consultation patients with Pseudodementia usually have very specific and exaggerated complaints and respond to tests with little cooperation since these produce a lot of anxiety, while patients with Dementia usually collaborate and are not afraid of tests.
The treatment of depressive pseudodementia focuses on the treating depression itself. Symptoms usually improve if depression is properly treated and the patient's mood improves. In a large number of cases, cognitive functioning can be fully recovered.
As a treatment for pseudodementia then psychotherapy, antidepressant medication or a combination of the two can be used. Both cognitive behavioral therapy and interpersonal therapy are proven effective treatments for depression, and as such can serve as a treatment for pseudodementia.
In the cognitive behavioral therapy Thought and behavior patterns are explored and modified to improve mood. In interpersonal therapy, interpersonal relationships are analyzed and ways in which they are contributing to depression are identified.
Although many cases of pseudodementia can be treated effectively by treating depression, it is important to note that research in recent years has found that reversible cognitive impairment in moderate or severe depression (that is, depressive pseudodementia) in older people can significantly predict subsequent dementia.
As a consequence, it is important, once the diagnosis is made and at the same time that depression is treated, to cognitively assess the patient in a comprehensive and comprehensive manner, in addition to offering careful monitoring.
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