by Danilo di Diodoro
Concentration difficulties, cognitive deficits and psychomotor retardation do not necessarily mean Alzheimer’s and there is the risk of confusing the symptoms with those of depression. How to make the diagnosis and the differences with true dementia
It can simulate a depressive state, but also other forms of mental disorder: pseudodementia. The term does not fall within the official diagnostic systems and is the subject of discussion among experts, but it is still used for its clinical usefulness, given that it allows us to distinguish some forms of mental deterioration which, once adequately treated, are reversible. In fact, pseudodementia can present with concentration difficulties, deficits in various cognitive functions and psychomotor retardation, symptoms which, especially in elderly people, suggest the beginning of an involutional process of the brain. instead it is a condition that can be stopped and reversed with adequate treatment says Salom Mouta of the Departamento de Psiquiatria e Saude Mental of the Unidade Local de Saude in Guarda, Portugal, first author of an article on the subject published in the journal General Psychiatry.
The risks of confusion with depression
On the contrary, even today the process of cerebral deterioration typical of true dementia cannot be stopped or significantly delayed. People with a moderate or severe depressive disorder may develop a decline in cognitive functions, with attention deficit, psychomotor retardation, difficulty thinking clearly, concentrating, making decisions, and a tendency to forget. It is therefore clear that there are risks of confusion between true dementia, depression and pseudodementia. Some studies indicate that between 20 and 30% of those who receive an initial dementia diagnosis may actually be suffering from a form of pseudodementia, with symptoms shared with a depressive disorder.
Symptoms
An elderly person who begins to have difficulty remembering names, to lose the fluency of speaking, to have memory gaps, to be unable to concentrate on his tasks, to have difficulty planning the day, to have emotional disturbances, will easily tend to think that perhaps you are heading towards brain deterioration, but in reality a depressive state can also be the cause of these symptoms. The difference lies both in the evolution of the two conditions and in their response to treatments. Furthermore, while in true dementia a process of physical involution of the brain is soon evident which can be detected with brain visualization techniques, in depressive forms this involution is absent or manifests itself in very limited areas, such as the hippocampus, when the disorder lasts a long time.
The diagnosis
The diagnosis of pseudodementia in adults/elderly people poses challenges due to several factors, says Mouta. First of all, the aging process itself involves changes in cognition and brain functioning, so that it becomes difficult to distinguish between simple changes due to age and the first signs of depression or true dementia. Furthermore, the diagnosis of pseudodementia is made complex by the fact that depressive symptoms and symptoms of various involutive neurological conditions can overlap in elderly people. Finally, it is also possible that a person can experience both true dementia and depression at the same time, which adds further difficulties to a correct diagnosis. The latter case is far from rare: approximately 30% of those suffering from vascular dementia or Alzheimer’s disease have evident depressive symptoms, as do 40% of those suffering from Parkinson’s disease. Due to the commonality of symptoms between dementia and depression, it can be difficult to understand whether someone living with dementia also suffers from depression.
Signs to watch out for
Some telltale signs may be the loss of interest and pleasure in activities that that person normally enjoyed doing, the tendency towards social isolation, the lack of energy, the negativity of thoughts and the loss of hope, or the presence of nihilistic feelings of lack of value, sadness, feelings of guilt, attempts at self-harm, growing confusion.
The treatments
As regards the available treatments, today specialists agree on the fact that in general, if a case of pseudodementia is suspected, it is best to first try to treat the depressive state or any other possible underlying mental disorder. Treatment of depression can vary from person to person, concludes Mouta. But usually based on both psychotherapeutic interventions and the use of antidepressant drugs. Starting treatment for depression can also help to distinguish pseudodementia from true dementia. And effective treatment will also be able to alleviate the cognitive malfunction associated with depression, with a significant improvement in symptoms.
The main differences between dementia and pseudodementia
Here are some differences between pseudodementia and dementia. In the first, the abrupt onset, usually days or weeks; slow and treacherous in the other. In the pseudo form, symptoms progress rapidly and tend to be worse in the morning; family members soon realize it. In the other the progression is slow and gradual, in the long term the symptoms worsen during the night and the family members initially do not notice the deficits and disabilities. As far as the subject is concerned, in easy pseudodementia he already has a history of depressive or manic symptoms. However, in dementia, a history of this type is rarely present. The mood also changes: depressed, with poor reactions to sad or cheerful situations, in the first form. Labile and superficial, with normal or exaggerated reaction to sad or happy situations in the second. The person with pseudodementia tends to underline their memory defects, while in dementia they tend to minimize, deny and hide their memory deficits.
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November 19, 2023 (modified November 19, 2023 | 4:22 pm)
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