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Pseudodementia is a syndrome seen in older people in which they exhibit symptoms consistent with dementia but the cause is a pre-existing psychiatric illness rather than a degenerative one.[1] The name is derived from the combining form of the Ancient Greek "ψευδής" (pseudēs, "false, lying"), prepended to "dementia".

Older people with predominant 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.[2] This was an important distinction as the former was untreatable and progressive and the latter treatable with antidepressant therapy or electroconvulsive therapy or both.[3]

History and controversy of term

The term was first coined in 1961 by psychiatrist Leslie Kiloh, who noticed patients with cognitive symptoms consistent with dementia who improved with treatment. His term was mainly descriptive.[4] The clinical phenomenon, however, was well-known since the late 19th century.[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 which has held up well in clinical practice, and also highlights those who may have a treatable condition.[8]

Presentation and differential

The history of disturbance in pseudodementia is often short and abrupt onset, while dementia is more often insidious. 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, and they may appear upset or distressed. Those with true dementia will often give wrong answers, have poor attention and concentration, and appear indifferent or unconcerned.[9]

Investigations such as SPECT imaging of the brain show reduced blood flow in areas of the brain in people with Alzheimer's disease, compared with a more normal blood flow in those with pseudodementia.[10]

References

  1. Sachdev, Perminder; JS Smith, H Angus-Lepan, P Rodriguez (1990). "Pseudodementia twelve years on". J Neurol Neurosurg Psychiatry 53 (3): 254–59. doi:10.1136/jnnp.53.3.254. PMC 1014139. PMID 2324757.
  2. Caine, ED (1981). "Pseudodementia. Current concepts and future directions". Archives of General Psychiatry 38 (12): 1359–64. PMID 7316680.
  3. Bulbena A & Berrios G E (1986) Pseudodementia: Facts and Figures. British Journal of Psychiatry 148: 87-94
  4. Kiloh, Leslie Gordon (1961). "Pseudodementia". Acta Psychiatr Scand 37: 336–51. PMID 14455934.
  5. Berrios GE (May 1985). ""Depressive pseudodementia" or "Melancholic dementia": a 19th century view". J. Neurol. Neurosurg. Psychiatr. 48 (5): 393–400. doi:10.1136/jnnp.48.5.393. PMC 1028324. PMID 3889224. http://jnnp.bmj.com/cgi/pmidlookup?view=long&pmid=3889224.
  6. McAllister, TW (May 1983). "Overview: Pseudodementia". American Journal of Psychiatry 140 (5): 528–33. PMID 6342420.
  7. Poon, Leonard W (1991). abstract "Toward an understanding of cognitive functioning in geriatric depression". International Psychogeriatrics 4 (4): 241–66. doi:10.1017/S1041610292001297. http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=272114 abstract.
  8. Sachdev, Perminder & Reutens, Sharon (2003). "The Nondepressive Pseudodementias". In V. Olga B. Emery, Thomas E. Oxman. Dementia: Presentations, Differential Diagnosis, and Nosology. JHU Press. p. 418. ISBN 0801871565.
  9. Wells, CE (May 1979). "Pseudodementia". American Journal of Psychiatry 136 (7): 895–900. PMID 453349.
  10. 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 052147275X.
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