Depressive Pseudodementia: Symptoms, Causes And Treatment

This alteration of cognitive abilities can appear in disorders such as depression.

Depressive pseudodementia

Many times, when a person suffers a depressive episode or disorder, their cognitive functions are altered; Thus, your ability to concentrate and your memory can decrease, for example.

When these alterations are of sufficient clinical severity, we are talking about a depressive pseudodementia. Let’s see what it consists of.

What is depressive pseudodementia?

Depressive pseudodementia consists of the presence of demented symptoms that also includes the mood alteration typical of depression. That is, the depressive picture is accompanied by severe cognitive impairment extensive enough to resemble or simulate dementia.

It is true that pseudodementia does not appear only in depression, but can appear in other functional psychopathological conditions. However, the most common is depression.

Symptoms

The characteristics (in addition to the depressive ones) we will see in more detail in the differential diagnosis section; However, the most important are: decreased ability to concentrate, difficulty remembering certain events (impaired immediate and short-term memory, for example), attention difficulties, etc.

Causes

Depressive pseudodementia appears as a result of depression; many times the patient is suffering such a negative and apathetic state that cognitive functioning is altered. Your psyche is so immersed in this state, as if there is no room for anything else. That is, it would be what we commonly call “not having a head at all.”

It should be noted that different longitudinal studies (Kral, 1983) have shown how many of the cases treated as depressive pseudodementia have subsequently evolved towards a real dementia, while other cases initially diagnosed as dementias have subsequently changed the diagnosis to depression.

Various explanatory theories have been proposed for this; one of them is that there is a continuum between depression, cognitive impairment and dementia in Alzheimer’s patients. Another is that it may be that some of those patients diagnosed with depressive pseudodementia could have already manifested Alzheimer’s disease in the early stages.

Differential diagnosis: depressive pseudodementia and Alzheimer’s

In clinical practice, it is easy to confuse the symptoms of dementia with those of depressive pseudodementia. Therefore, it is important to analyze the differences between one and the other.

We are going to analyze the differential diagnosis of the most common dementia, Alzheimer’s, with respect to depressive pseudodementia.

Alzheimer’s dementia: characteristics

The onset in this type of dementia is poorly defined, and its onset is slow. The deterioration is progressive and there is no awareness of the disease. Generally the patient does not recognize the limitations and they do not usually affect him. They show a labile or inappropriate mood.

Attention is deficient. Short-term memory (MCP) is always affected; in long-term memory (LTM), memory failure is progressive. As for language, they usually present anomie.

The behavior is consistent with the deficit, and is usually compensatory. Social deterioration is slow. The symptoms are also congruent, with nocturnal aggravation, global impairment of yields, and imprecise complaints (which are less than those objectified).

In medical tests these patients cooperate, and they produce little anxiety. The results are usually constant. The responses shown by the patient are often evasive, erroneous, conniving, or persistent. Successes stand out.

Regarding the response to antidepressant treatment, treatment does not reduce cognitive symptoms (it only improves depressive symptoms).

Depressive pseudodementia: characteristics

Let’s now look at the differences between Alzheimer’s and depressive pseudodementia. In depressive pseudodementia, all of the above characteristics vary. Thus, its beginning is well defined and its beginning is fast. The evolution is uneven.

Patients have a marked disease awareness, and adequately recognize and perceive its limitations. These are badly experienced. Her mood is usually sad and flat.

Attention is preserved. The MCP is sometimes decreased, and the MLP is often inexplicably altered. There are no alterations in language.

Their behavior is not consistent with the deficit, and this is usually abandonment. Social decline appears early.

The symptoms are exaggerated by the patient (more complaints appear than those objectified), and the complaints are specific. Furthermore, patients respond to medical tests with little cooperation, and their success is variable. These cause anxiety. The answers they usually show are global and disinterested (of the “I don’t know” type). Flaws stand out.

Treatment with antidepressants improves mood, and consequently cognitive symptoms also improve, unlike dementia, where cognitive symptoms do not improve with antidepressants.

Treatment

E l treatment of depressive pseudo – dementia should focus on the treatment of depression itself, since improving this, improve cognitive symptoms. Thus, the most complete treatment will be a cognitive behavioral (or only behavioral) treatment combined with pharmacological treatment.

Behavioral therapy is also indicated, as well as interpersonal therapy or third-generation therapies (eg, Mindfulness).

Yoga or sports also tend to have beneficial effects in reducing anxiety symptoms, which are often associated with depression. In addition, they help reduce stress, reduce rumination and sleep better.

Bibliographic references:

  • Arango, JC. and Fernández, S. (2003). Depression in Alzheimer’s disease. Latin American Journal of Psychology, 35 (1), 41-54.
  • Belloch, A., Sandín, B. and Ramos, F. (2010). Manual of Psychopathology. Volume II. Madrid: McGraw-Hill.
  • Emery, VO; Oxman, TE (1997). “Depressive dementia: A ‘transitional dementia’?”. Clinical Neuroscience. 4 (1): 23–30.
  • Kral, VA (1983). The Relationship between Senile Dementia (Alzheimer Type) and Depression. 28 (4). https://doi.org/10.1177/070674378302800414.

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