Pseudodementia is a condition in older people that mimics dementia but is actually caused by depression. Symptoms include memory loss, poor self-care, and confusion. Treatment involves antidepressants, with electroconvulsive therapy as a last resort. Antipsychotics should not be used in the elderly. Early treatment for depression may prevent both pseudodementia and true dementia.
Pseudodementia is a term coined in the early 1960s to describe a condition in older people who appear to have dementia, but are actually suffering from depression that causes dementia-like symptoms. These symptoms such as apparent memory loss or an inability to take proper care of themselves may co-occur with symptoms of depression, and a person may seem confused or may not be able to answer common tests that evaluate for dementia. many questions except saying: I don’t know.” It is important to view pseudodementia as a real disease and not something a person “fakes”. It’s really depression masquerading as conditions like Alzheimer’s, though it hasn’t been listed in diagnostic and statistical manuals since the mid-1990s.
Symptoms of this disease are similar to those of true dementia and could include evidence of memory loss, poor self-care, confusion, and difficulty concentrating. The typical differences are generally that a person may seem emotionally depressed, listless, sad, and hopeless. Other symptoms of depression such as chronic pain or major changes in sleep habits may also be present.
There are two therapeutic approaches to this disease. One is to give antidepressants. When people fail to respond to these, electroconvulsive therapy might be tried. The latter treatment is usually not a good first choice, as it can cause memory loss.
The good news about pseudodementia is that most people respond to treatment with antidepressants, and symptoms of dementia can completely subside if people are properly treated for depression. Since it is usually older people who develop pseudodementia, caution should be exercised when prescribing medicines. For example, the use of most antipsychotic drugs, such as Seroquel® (quetiapine), would not be considered a viable treatment in the elderly, but has been shown to be a viable adjunctive therapy in the young.
Most antipsychotics have been linked to a higher rate of sudden death in the elderly. Organizations such as the United States Food and Drug Administration (FDA) give these a black box warning and strongly recommend that they not be used with elderly populations. In most cases, depression resolves without these medications and can be treated adequately with antidepressants.
There is great interest in conditions such as pseudodementia because depression is sometimes seen as a precursor to true dementia. Some doctors, while acknowledging a stark difference between these two conditions, suggest that there may be unknown connections between the two diseases. It has been hypothesized by some specialists that depression undiagnosed in later years could cause a greater susceptibility to true dementia, even if it risks the development of pseudodementia. An early response to treatment for depression possibly avoids both conditions.
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