Depressive pseudodementia: symptoms, causes and treatment

Often, when a person suffers from an episode or a depressive disorder, their cognitive functions are impaired; thus, it may decrease your ability to concentrate and your memory, for example.

When these changes are of sufficient clinical severity, we speak of a picture of depressive pseudodementia. Let’s see what it is.

    What is depressive pseudodementia?

    Depressive pseudodementia is the presence of symptoms of dementia that also include the mental disorder of depression. In other words, the depressive picture is accompanied by severe cognitive impairment extensive enough to resemble or simulate dementia.

    It is true that pseudodementia it doesn’t just appear in depression, But may appear in other functional psychopathological images. However, depression is the most common.

    symptoms

    The features (in addition to the depressive features) will be discussed in more detail in the section on differential diagnosis; however, the most important are: decreased ability to concentrate, difficulty remembering certain events (Immediate and short-term memory problems, for example), difficulty in paying attention, etc.

    the causes

    Depressive pseudodemence appears as a result of depression; several times the patient suffers a state so negative and listless that cognitive functioning is impaired. His psyche is so immersed in this state, as if there is no room for anything else. In other words, it would be what we commonly call “having nothing to do with”.

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

    Several explanatory theories have been advanced for this; the first is that there is a continuum between depression, cognitive impairment and dementia in people with Alzheimer’s disease. Another is that some of these patients diagnosed with depressive pseudodementia may have already manifested Alzheimer’s disease at an early stage.

      Differential diagnosis: depressive pseudodementia and Alzheimer’s disease

      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 them.

      We will analyze the differential diagnosis of the most common dementia, Alzheimer’s disease, versus depressive pseudodementia.

      Alzheimer’s dementia: characteristics

      The onset of this type of dementia is poorly defined and its onset is slow. The deterioration is gradual and there is no awareness of the disease. In general, the patient does not recognize the limits and they usually do not affect him. They show labile or inappropriate humor.

      Attention is insufficient. Short-term memory (MCP) is always affected; in long-term memory (MLP), the memory decision is progressive. As for the language, they generally present an anomie.

      The behavior is compatible with a deficit and is generally compensatory. Social deterioration is slow. The clinic is also congruent, with nocturnal worsening, overall allocation of inaccurate returns and complaints (Which are smaller than those targeted).

      In medical tests, these patients cooperate, and these cause them little anxiety. The results are generally consistent. Responses shown by the patient are generally evasive, erroneous, conspiratorial or persevering. The successes stand out.

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

      Depressive pseudodementia: characteristics

      Now let’s look at the differences between Alzheimer’s disease and depressive pseudodementia. In depressive pseudodementia, all of the above characteristics vary. like that, its beginning is well defined and its onset is rapid. The evolution is uneven.

      Patients have a marked awareness of the disease and adequately recognize and perceive its limitations. These are badly experienced. His mood is generally sad and flattened.

      Attention is preserved. MCP is sometimes decreased and MLP is often inexplicably altered. There is no change in the language.

      Their behavior is incompatible with the deficit, and it is usually neglect. Social deterioration appears early.

      Symptoms are exaggerated by the patient (More complaints appear than objectified complaints), and the complaints are specific. In addition, patients respond to medical tests with little cooperation and their success varies. It causes them anxiety. The answers they generally give are comprehensive and disinterested (of the “I don’t know” type). Chess stands out.

      Antidepressant treatment improves mood and therefore cognitive symptoms improve as well, unlike dementia where cognitive symptoms do not improve with antidepressants.

      treatment

      ETreatment of depressive pseudodementia should focus on treating the depression itselfBecause by improving this, cognitive symptoms improve. Thus, the most comprehensive treatment will be behavioral cognitive treatment (or behavioral only) combined with pharmacological treatment.

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

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

      Bibliographical 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’s type) and depression. 28 (4). https://doi.org/10.1177/070674378302800414.

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