Definition: Basically, pseudodementia is a condition in which
symptoms of dementia are caused by depression rather than an organic disease such as Alzheimer's.
When younger people get depressed, they often suffer from
obsessions or feelings of anxiety--they may agonize over their
problems to no end and spend a lot of time talking (or whining) about
whatever's bothering them. In the elderly, however, depression more
commonly involves feelings of apathy--older people who are depressed
will feel that life has no meaning, that their best and happiest days are
behind them, and that there's no point in trying anything anymore. In
turn, the apathy may make them seem forgetful or confused; they'll miss
appointments, forget to enter checks in their checkbook, and seem "out of
touch" in conversations. They may even appear impaired on
neuropsychological tests of memory and concentration.
This syndrome is called pseudodementia and is one of the
reversible causes of dementia-like symptoms.
Diagnosis: Obviously, you can start by asking the patient if
he or she is depressed; however, elderly adults often show quite a bit of
reticence when they're asked to discuss their moods and emotions with
strangers, so you might not get an accurate answer. Often, an indirect
approach works better: you can ask if they recently experienced a tragic
event (such as the loss of a spouse), a significant change in lifestyle
(retirement and a shift to a smaller fixed income), or an illness
(anything from incurable cancer to a relatively minor injury that
prevents them from pursuing a favorite hobby). If so, it's worth
considering treatment for depression.
Treatment: As with most forms of depression,
antidepressants work well. ECT often provides relief
if the drugs fail and the case is severe; however, shock therapy often
causes brief memory loss, thereby worsening the symptom you're trying to
alleviate. Ultimately, though, doctors prefer not to keep the elderly on
medications if they don't have to, so it's useful to try to find some
non-pharmacological way to keep them happy and healthy. Patients in this
situation should be encouraged to pick up new hobbies, join church
organizations, go to senior citizens' meetings, go on trips, meet new
people--in short, they should do as much as they can for as long as they
Technically, pseudodementia is only diagnosed when other organic
diseases are absent. Depression is, however, common in people who have
Alzheimer's disease or multi-infarct dementia (which makes sense;
patients with these diseases often are the first to know they're having
troubles and, quite understandably, get depressed about it).
Antidepressants may help these patients to an extent; unfortunately, they
cannot cure the disorder entirely.