Pseudodementia: Symptoms, Causes & Treatment

Pseudodementia, often called depressive pseudodementia, is a type of dementia that mimics other neurodegenerative dementias in appearance but is caused by another mental illness, often depression. Pseudodementia patients exhibit cognitive deficiencies or memory problems, with underlying psychiatric disorders being the primary cause. Because the symptoms of depression, dementia, and pseudodementia overlap, it can be challenging to distinguish between them.

Researchers have shown that 0.6% of adults 65 years of age or older had depressive pseudodementia. Patients who come in for cognitive decline testing may have higher rates. Pseudo-cognition negatively affects speech and language, memory, and executive function, which are the main aspects of cognitive functioning.

In this article, we will explore the history, symptoms, causes, diagnosis and treatment of pseudodementia. We will also shed some light on the difference between dementia and pseudodementia.

Also Read New Finding: Dementia Patients Retain Learning Abilities!

History of Pseudo dementia:

Leslie Kiloh, a psychiatrist, popularised “pseudodementia” in 1961. Kiloh’s study from that period, which was published in the professional journal “Acta Psychiatrica Scandinavica”, included vignettes of 10 patients, the majority of whom displayed depressed symptoms.

While it was believed at the time that dementia could not be reversed, his research showed that cognitive impairments linked to psychiatric conditions like schizophrenia and depression might be curable.

Symptoms of Pseudodementia:

Major symptoms of pseudodementia, include:

1. Difficulty in speaking.
2. Learning disabilities.
3. Loss of memory.
4. Finding it difficult to focus or change focus between tasks.
5. Issues in organising and planning.
6. Difficulty controlling feelings.

Also Read: Dementia Patients Do Not Receive Post-Diagnosis Care

Common symptoms of depression manifest in pseudodementia, include:

1. Feeling down or depressed.
2. Absence of pleasure for routine tasks or interests.
3. Having trouble focusing or making decisions.
4. Weight fluctuation without making an effort to adjust weight.
5. Shift in sleeping patterns, which might include getting either little or too much sleep.
6. Suffering from feelings of worthlessness or experiencing excessive guilt
7. Variations in motor activity can show up as either a pronounced slowing down of movement or restlessness.
8. Experiencing great exhaustion and/or difficulty doing everyday tasks due to poor energy and ineffectiveness.
9. Thoughts of suicide or attempt of suicide.

Causes of Pseudodementia:

As depression can cause cognitive impairment, it is one of the main mood disorders associated with pseudodementia.
Other causes include:

1. Cognitive Factors: The hypothalamic-pituitary axis is, altered by elevated stress and depression, which results in cognitive impairment.
2. Psychological Factors: Psychosocial and environmental problems, such as substance abuse, unpleasant life events, inadequate social support, and mental and physical abuse.
3. Neurological Factors: Problems with the neural pathways connecting the frontal and temporal lobes to the amygdala, the emotional centre of the brain.
4. Neuroendocrine Factors: Cognitive impairment results from hippocampal neuronal loss.
5. Genetic Factors: It is associated with depressed cognitive impairments, including repetitions in chromosome 9 (C9ORF72).

Read More: Risk of Early Dementia with Mental Disorders

Diagnosis of Pseudodementia:

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not officially recognise pseudodementia as a diagnosis. Rather, it’s an informal phrase for cognitive impairment associated with psychological disorders, most commonly depression. Although there are no formal diagnostic standards for the illness, a doctor or other medical practitioner may refer to the cognitive impairment that results from depression as pseudodementia.

To rule out neurodegenerative causes of cognitive loss, the diagnosing therapist may inquire about the beginning and duration of symptoms. They may also perform memory and learning assessments, laboratory testing, and brain scans.

Treatment of Pseudodementia:

Finding and treating the underlying cause of pseudodementia’s symptoms is the aim of treatment. After receiving effective treatment for depression, pseudodementia symptoms typically get better.

Therapy:

Cognitive behavioural therapy (CBT) and interpersonal therapy are the two most popular forms of therapy for pseudodementia.

1. Interpersonal Therapy:

The patient’s interactions with friends, family, and other people are the main emphasis of interpersonal therapy. It also looks at the patients’ self-perceptions.

2. Cognitive Behavioural Therapy (CBT):

Through teaching patients how to change troublesome behaviours, cognitive behavioural therapy helps patients become more aware of their negative thought patterns. Therapists also impart coping mechanisms and methods to patients and carers to get better results.

3. Reminiscence Therapy:

For those who suffer from memory impairment, reminiscence therapy may be helpful. It assists individuals in retrieving memories from the past by using all of their senses.

Medications:

The most widely prescribed antidepressant drugs for depression belong to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). SSRIs include citalopram (Cipramil), escitalopram (Cipralex), and fluoxetine (Prozac).

Electroconvulsive Therapy (ECT):

Under general anaesthesia, ECT is a medical procedure that involves momentarily stimulating the brain. It might be suggested as a substitute strategy for depression that is resistant to treatment. According to some research, ECT can treat pseudodementia symptoms.

Dementia v/s Pseudodementia:

There exist multiple factors that aid in differentiating between pseudodementia and dementia. Specifically, pseudodementia and depression may be curable, whereas dementia may be more difficult to cure, contingent on its stage and advancement.

1. Brain Scans:

The primary distinction between the two conditions is that, while true dementia results in actual brain degeneration, pseudodementia does not. Pseudodementia and dementia therefore cause very similar symptoms, but they will show up differently on brain scans.

2. Neuropsychological Testing:

Test results may also reveal the disparities between these two. For instance, a person suffering from dementia frequently isn’t aware that they have memory issues, yet they will perform poorly on neuropsychological tests. The opposite could apply to a person suffering from cognitive symptoms of depression. Despite their claims of having memory issues, they score highly on neuropsychological tests.

3. Respond to Treatment:

Pseudodementia frequently reacts to treatment. Treating the underlying depression in pseudodementia due to depression frequently results in a significant improvement in the symptoms. Since there is presently no known cure for dementia, treatment for these instances may concentrate on symptom control.

4. Results of the Geriatric Depression Scale Test:

The self-reported Geriatric Depression Scale (GDS) serves as a test that can be very helpful in differentiating between PDEM and dementia. To aid in the diagnosis, the GDS results are paired with details on the patient’s past and present functioning. For instance, those who have pseudodementia are more likely to score highly on the GDS (high = more depressed) and do not often have a history of mood fluctuations. People who suffer from dementia exhibit a spectrum of emotions.

Books, which can help you to get more about Dementia:

• The 36-Hour Day, 6th Edition
• Learning to Speak Alzheimer’s: A Groundbreaking Approach for Everyone Dealing with the Disease
• Tangles: A Story About Alzheimer’s, My Mother, and Me