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Pseudodementia

From Wikipedia, the free encyclopedia
Psuedodementia
Other namesDepression-related cognitive dysfunction, depressive cognitive disorder, pseudosenility,[1] reversible dementia[2]
SpecialtyPsychiatry
CausesDepression, schizophrenia, psychosis, and other psychiatric conditions that can impair cognitive functions

Pseudodementia (otherwise known as depression-related cognitive dysfunction or depressive cognitive disorder) is a condition where mental cognition can be temporarily decreased due to psychiatric conditions, especially depression. Pseudodementia can develop in a wide range of functional psychiatric conditions such as depression, schizophrenia and other psychosis, mania, dissociative disorder and conversion disorder. The presentations of pseudodementia may mimic organic dementia, but are essentially reversible on treatment and doesn't lead to actual brain degeneration. 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 attentional control 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. Two treatments found to be effective for the treatment of depression may also be beneficial in the treatment of pseudodementia: Cognitive behavioral therapy (CBT) which identifies behaviors that positively and negatively impact mood, and Interpersonal therapy which focuses on identifying ways in which interpersonal relationships contribute to depression.

History

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The term was first coined in 1961 by psychiatrist Leslie Kiloh, who noticed patients with cognitive symptoms consistent with dementia who improved with treatment. Reversible causes of true dementia must be excluded.[3] His term was mainly descriptive.[4] The clinical phenomenon, however, has been well-known since the late 19th century as melancholic dementia.[5]

Doubts about the classification and features of the syndrome,[6] and the misleading nature of the name, led to proposals that the term be dropped.[7] However, proponents argue that although it is not a defined singular concept with a precise set of symptoms, it is a practical and useful term that has held up well in clinical practice, and also highlights those who may have a treatable condition.[8]

Presentation

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The history of disturbance in pseudodementia is often short and abrupt onset, while dementia is more often insidious. In addition, there is often minor, or an absence of, any abnormal brain patterns seen via imaging.[9] The key symptoms of pseudodementia include: speech impairments, memory deficits, attention problems, emotional control issues, organization difficulties, and decision making.[10] Clinically, people with pseudodementia differ from those with true dementia when their memory is tested. They will often answer that they don't know the answer to a question, and their attention and concentration are often intact. They may appear upset or distressed, and those with true dementia will often give wrong answers, have poor attention and concentration, and appear indifferent or unconcerned. The symptoms of depression oftentimes mimic dementia even though it may be co-occurring.[11]

Causes

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Pseudodementia refers to "behavioral changes that resemble those of the progressive degenerative dementias, but which are attributable to so-called functional causes".[12] While the main cause of pseudodementia is depression, other mental health conditions (i.e. schizophrenia, psychoses, etc.) have also been noted to cause symptoms related to dementia.[13] These psychiatric conditions can cause cognitive impairment, described as the slowing of functions such as thinking, memory, and speech.[14]

Diagnosis

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Differential diagnosis

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There is currently no cure for dementia. However, other psychiatric disorders that may result in dementia-like symptoms are able to be treated. Thus, it is essential to complete differential diagnosis, where other possibilities are appropriately ruled out to avoid misdiagnosis and inappropriate treatment plans.[15]

The implementation and application of existing collaborative care models, such as DICE, can aid in avoiding misdiagnosis. Comorbidities (such as vascular, infectious, traumatic, autoimmune, idiopathic, or even becoming malnourished) have the potential to mimic symptoms of dementia.[16] For instance, studies have also shown a relationship between depression and its cognitive effects on everyday functioning and distortions of memory.[17]

Investigations such as PET and SPECT imaging of the brain show reduced blood flow in areas of the brain in people with Alzheimer's disease (AD) compared with a more normal blood flow in those with pseudodementia, and the MRI shows medial temporal lobe atrophy in people with AD.[18]

Pseudodementia vs. dementia

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Pseudodementia symptoms can appear similar to dementia. Due to the similar signs and symptoms to dementia, it can result in a misdiagnosis of depression, or the adverse effects of medications being taken.[19] This form of dementia is not the original form and does not result from the same cognitive changes. Once the depression is properly treated or the medication therapy is modified, the cognitive impairment can be effectively reversed. Generally, dementia involves a steady and irreversible cognitive decline while pseudodementia induced symptoms are reversible.[19] Diminished mental capacity and social withdrawal are commonly identified as symptoms in the elderly but oftentimes is due to symptoms of depression but not dementia.[20] As a result, elderly patients are often misdiagnosed especially when healthcare professionals do not make an accurate assessment or suggest the correct testing.

Older people with predominantly cognitive symptoms such as loss of memory, and vagueness, as well as prominent slowing of movement and reduced or slowed speech, were sometimes misdiagnosed as having dementia when further investigation showed they were suffering from a major depressive episode.[21] This was an important distinction as the former was untreatable and progressive and the latter treatable with antidepressant therapy, electroconvulsive therapy, or both.[22] In contrast to major depression, dementia is a progressive neurodegenerative syndrome involving a pervasive impairment of higher cortical functions resulting from widespread brain pathology.[3]

A significant overlap in cognitive and neuropsychological dysfunction in Dementia and pseudodementia patients increases the difficulty in diagnosis. Differences in the severity of impairment and quality of patients' responses can be observed, and a test of antisaccadic movements may be used to differentiate the two, as pseudodementia patients have poorer performance on this test.[2] Individuals with pseudodementia present considerable cognitive deficits, including disorders in learning, memory and psychomotor performance. Substantial evidences from brain imaging such as CT scanning and positron emission tomography (PET) have also revealed abnormalities in brain structure and function.[2]

A comparison between dementia and pseudodementia is shown below.[2]

Variable Pseudodementia Dementia
Onset More precise, usually in terms of days or weeks Subtle
Course Rapid, uneven Slow, worse at night
Past history Depression or mania frequently Uncertain relation
Family history Depression or mania Positive family history for dementia in approximately 50% DAT
Mood Depressed; little or no response to sad or funny situations; behavior and affect inconsistent with degree of cognitive deficit Shallow or labile; normal or exaggerated response to sad or funny situations; consistent with degree of cognitive impairment
Cooperation Poor; little effort to perform well; responds often with "I don't know"; apathetic, emphasizes failure Good; frustrated by inability to do well; response to queries approximate con fabricated or perseverated; emphasizes trivial accomplishment
Memory Highlight memory loss; greater impairment of personality features (e.g. confidence, drive, interests, and attention) Denies or minimizes impairments; greater impairment in cognitive features (recent memory and orientation to time and date)
Mini-Mental State Exam (MMSE).[23] Changeable on repeated tests Stable on repeated tests
Symptoms Increased psychologic symptoms: sadness, anxiety, somatic symptoms Increased neurologic symptoms: dysphasia, dyspraxia, agnosia, incontinence
Computed Tomography (CT) and Electroencephalogram (EEG) Normal for age Abnormal

Treatments

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If effective medical treatment for depression is given, this can aid in the distinction between pseudodementia and dementia. Antidepressants have been found to assist in the elimination of cognitive dysfunction associated with depression, whereas cognitive dysfunction associated with true dementia continues along a steady gradient. In cases where antidepressant therapy is not well tolerated, patients can consider electroconvulsive therapy as a possible alternative.[19] However, studies have revealed that patients who displayed cognitive dysfunction related to depression eventually developed dementia later on in their lives.

The development of treatments for dementia has not been as fast as those for depression. Hence, the pharmacological treatments for pseudodementia do not directly treat the condition itself but directly treat dementia, depression, and cognitive impairment. These medications include SSRI (Selective Serotonin Reuptake Inhibitor), SNRI (Serotonin-norepinephrine Reuptake Inhibitors), TCAs (Tricyclic antidepressants), Zolmitriptan, Vortioxetine, and cholinesterase inhibitors. [24]

References

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  1. ^ Libow LS (March 1973). "Pseudo-senility: acute and reversible organic brain syndromes". J Am Geriatr Soc. 21 (3): 112–20. doi:10.1111/j.1532-5415.1973.tb00855.x. PMID 4702407. S2CID 23256265.
  2. ^ a b c d Nixon, S.J. (1996) Secondary dementias: reversible dementias and pseudomentia in R.L. Adams, O.A. Parsons, J.L. Culbertson & S.J. Nixon (Eds.) Neuropsychology for Clinical Practice: etiology, assessment, and treatment of common neurological disorder. (pp. 107–130). Washington, DC: American Psychological Association
  3. ^ a b Warrell, David; Timothy, Cox; John, Firth (2010). "Neuropsychiatric disorders". Oxford Textbook of Medicine. pp. 5268–5283. doi:10.1093/med/9780199204854.003.2604. ISBN 9780199204854.
  4. ^ Kiloh, Leslie Gordon (1961). "Pseudodementia". Acta Psychiatr Scand. 37 (4): 336–51. doi:10.1111/j.1600-0447.1961.tb07367.x. PMID 14455934. S2CID 221390518.
  5. ^ Berrios GE (May 1985). ""Depressive pseudodementia" or "Melancholic dementia": a 19th century view". J. Neurol. Neurosurg. Psychiatry. 48 (5): 393–400. doi:10.1136/jnnp.48.5.393. PMC 1028324. PMID 3889224.
  6. ^ McAllister, TW (May 1983). "Overview: Pseudodementia". American Journal of Psychiatry. 140 (5): 528–33. doi:10.1176/ajp.140.5.528. PMID 6342420.
  7. ^ Poon, Leonard W (1991). "Toward an understanding of cognitive functioning in geriatric depression". International Psychogeriatrics. 4 (4): 241–66. doi:10.1017/S1041610292001297. PMID 1288665.
  8. ^ Sachdev, Perminder; Reutens, Sharon (2003). "The Nondepressive Pseudodementias". In V. Olga B. Emery; Thomas E. Oxman (eds.). Dementia: Presentations, Differential Diagnosis, and Nosology. JHU Press. p. 418. ISBN 0-8018-7156-5.
  9. ^ Sachdev, P S; Smith, J S; Angus-Lepan, H; Rodriguez, P (March 1990). "Pseudodementia twelve years on". Journal of Neurology, Neurosurgery, and Psychiatry. 53 (3): 254–259. doi:10.1136/jnnp.53.3.254. ISSN 0022-3050. PMC 1014139. PMID 2324757.
  10. ^ Mouta, Salomé; Fonseca Vaz, Isabel; Pires, Miguel; Ramos, Sara; Figueiredo, Diana (2023-08-22). "What do we know about pseudodementia?". General Psychiatry. 36 (4): e100939. doi:10.1136/gpsych-2022-100939. ISSN 2517-729X. PMID 37622032.
  11. ^ Wells, CE (May 1979). "Pseudodementia". American Journal of Psychiatry. 136 (7): 895–900. doi:10.1176/ajp.136.7.895. PMID 453349.
  12. ^ Jones, R.D., Tranel, D., Benton, A. & Paulsen, J (1992). "Differentiating dementia from "pseudodementia" early in the clinical course: utility of neuropsychological tests". Neuropsychology. 6 (1): 13–21. doi:10.1037/0894-4105.6.1.13. ISSN 1931-1559.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ^ Mouta, Salomé; Vaz, Isabel Fonseca; Pires, Miguel; Ramos, Sara; Figueiredo, Diana (2023-08-01). "What do we know about pseudodementia?". General Psychiatry. 36 (4): e100939. doi:10.1136/gpsych-2022-100939. ISSN 2517-729X.
  14. ^ Shnaidman, Vivian Chern (2016-01-01), Shnaidman, Vivian Chern (ed.), "3 - The Mental Status Examination v. Common Sense", Forensic Psychiatry, San Diego: Academic Press, pp. 35–47, doi:10.1016/b978-0-12-802852-0.00003-7, ISBN 978-0-12-802852-0, retrieved 2024-07-24
  15. ^ Brodaty, Henry; Connors, Michael H. (January 2020). "Pseudodementia, pseudo‐pseudodementia, and pseudodepression". Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring. 12 (1). doi:10.1002/dad2.12027. ISSN 2352-8729. PMC 7167375. PMID 32318620.
  16. ^ Kverno, Karan S. and Roseann Velez. “Comorbid Dementia and Depression: The Case for Integrated Care.” Journal for Nurse Practitioners Volume 14, Issue 3, March 2018, Pages 196-201. https://doi.org/10.1016/j.nurpra.2017.12.032
  17. ^ Sjunaite, Karolina, Claudia Lanza, and Matthias W. Riepe. “Everyday false memories in older persons with depressive disorder.” Psychiatry Research 261 (2018): 456-463. https://doi.org/10.1016/j.psychres.2018.01.030
  18. ^ Parker, Gordon; Dusan Hadzi-Pavlovic; Kerrie Eyers (1996). Melancholia: A disorder of movement and mood: A phenomenological and neurobiological review. Cambridge: Cambridge University Press. pp. 273–74. ISBN 0-521-47275-X.
  19. ^ a b c Thakur, Mugdha Ekanath. "Pseudodementia." Encyclopedia of Health & Aging, edited by Kyriakos S. Markides, SAGE Reference, 2007, pp. 477-478. Gale Virtual Reference Library. Accessed 5 July 2018. (subscription required)
  20. ^ Venes, Donald. Taber's Cyclopedic Medical Dictionary.Philadelphia: F.A. Davis Company, [2017] Print.
  21. ^ Caine, ED (1981). "Pseudodementia. Current concepts and future directions". Archives of General Psychiatry. 38 (12): 1359–64. doi:10.1001/archpsyc.1981.01780370061008. PMID 7316680.
  22. ^ Bulbena A, Berrios GE (1986). "Pseudodementia: Facts and figures". The British Journal of Psychiatry. 148 (1): 87–94. doi:10.1192/bjp.148.1.87. PMID 3955324.
  23. ^ Folstein MF, Folstein SE, McHugh PR (November 1975). "'Mini-mental state'. A practical method for grading the cognitive state of patients for the clinician". J Psychiatr Res. 12 (3): 189–98. doi:10.1016/0022-3956(75)90026-6. PMID 1202204.
  24. ^ Sekhon, Sandeep; Marwaha, Raman (2024), "Depressive Cognitive Disorders", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32644682, retrieved 2024-07-23

Further reading

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