What is Pseudodementia?

Pseudodementia is a term coined in the early 1960s to a describe a condition in elderly people who appear to be suffering from dementia, but actually are suffering from depression which is causing dementia-like symptoms. These symptoms like apparent memory loss or failure to adequately be able to care for the self may present concurrently with symptoms of depression, and a person may seem confused or on common tests that evaluate dementia be unable to answer many questions except by saying, “I don’t know.” It is important to view pseudodementia as a real illness and not something a person “fakes.” It really is depression that masquerades as conditions like Alzheimer’s, though it has not be been listed in the Diagnostic and Statistical Manuals since the mid 1990s.

Symptoms of this illness are similar to those of true dementia, and could include evidence of memory loss, poor self-care, confusion, and difficulty concentrating. The hallmark differences are generally that a person may seem emotionally depressed, listless, sad, and hopeless. Other symptoms of depression like chronic pain or major changes in sleep habits could be present too.

There are two treatment approaches toward this illness. One is to give antidepressants. When people fail to respond to these, electro-convulsive therapy might be tried. The latter treatment is usually not a good first choice, since it can result in some memory loss.

The good news about pseudodementia is most people respond to treatment with antidepressants and the symptoms of the dementia state may completely reverse if people are adequately treated for depression. Since normally it is elderly people who develop pseudodementia, caution must be taken in prescribing medicines. For example, use of most antipsychotic drugs, like Seroquel® (quetiapine), would not be considered a viable treatment in seniors, but it has been shown to be a valuable add-on therapy in younger people.

Most of the antipsychotics have been linked to a higher rate of sudden death in seniors. Organizations like the US Food and Drug Administration (FDA) give these a black box warning and strongly recommend they not be used with elderly populations. In most instances, depression is reversed without these medicines and can be treated adequately with antidepressants.

There is a great deal of interest in conditions like pseudodementia because depression is sometimes seen as a precursor to real dementia. Some doctors, while acknowledging a strong difference between these two conditions, suggest there may be unknown connections between the two illnesses. It’s been posited by some specialists that undiagnosed depression in later years might cause greater predisposition for true dementia, even as it risks development of pseudodementia. Possibly early response to treating depression avoids both conditions.