Depressive pseudodementia: symptoms, causes and treatment

This alteration of cognitive abilities can appear in disorders such as depression.

Many times, when a person suffers a depressive episode or disorder, their cognitive functions are altered; thus, their ability to concentrate and their memory may be diminished, for example.

When these disturbances are of sufficient clinical severity, we are talking about a picture of depressive pseudodementia.. Let us see what it consists of.

What is depressive pseudodementia?

The depressive pseudodementia consists of the presence of depressive pseudodementia consists of the presence of dementing symptomatology that also includes the mood alteration characteristic of depression.. That is, the depressive picture is accompanied by severe cognitive impairment sufficiently extensive to resemble or simulate dementia.

It is true that pseudodementia does not appear only in depression does not appear only in depressionbut it can also appear in other functional psychopathological conditions. However, the most frequent is depression.

Symptoms

The characteristics (in addition to the depressive ones) we will see them in more detail in the section of differential diagnosis; however, the most important are: decreased ability to concentrate, difficulty in remembering certain events (impairment of immediate memory). (e.g., impairment of immediate and short-term memory), attentional difficulties, etc.

Causes

Depressive pseudodementia appears as a result of depression; many times the patient is suffering from such a negative and such a negative and apathetic state that cognitive functioning is impaired.. His psyche is so immersed in this state, as if there were no room for anything else. In other words, it would be what we commonly call "not having a head for anything".

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

Several explanatory theories have been put forward for this; one of them is that there is a continuum between depression, cognitive impairment and dementia in subjects with Alzheimer's disease. Another is that it may be that some of these patients diagnosed with depressive pseudodementia may have already manifested Alzheimer's disease in the early stages.

Differential diagnosis: depressive pseudodementia and Alzheimer's disease.

In clinical practice, it is easy to confuse the symptoms of dementia with those of a depressive pseudodementia.. Therefore, it is important to analyze the differences between the two.

We will analyze the differential diagnosis of the most common dementia, Alzheimer's dementia, with respect to depressive pseudodementia.

Alzheimer's dementia: characteristics

The onset of this type of dementia is poorly demarcated, and its onset is slow. The deterioration is progressive and there is no awareness of the disease.. Generally the patient does not recognize the limitations and they usually do not affect him/her. They show a labile or inadequate mood.

Attention is deficient. Short-term memory (STM) is always affected; in long-term memory (LTM), memory failure is progressive. As for language, they usually present anomia.

Behavior is consistent with the deficit, and is usually compensatory. Social deterioration is slow. The clinical picture is also congruent, with nocturnal aggravation, global affectation of performances and vague complaints (which are less than those objectified).

In medical tests these patients are cooperative, and these cause them little anxiety. The results are usually consistent. The patient's responses are usually evasive, erroneous, confabulated or perseverative.. Successes stand out.

As for the response to treatment with antidepressants, the treatment does not reduce cognitive symptomatology (only improves depressive symptomatology).

Depressive pseudodementia: features

Let us now look at the differences between Alzheimer's disease and depressive pseudodementia. In depressive pseudodementia, all the above characteristics vary. Thus, its onset is well demarcated and its onset is rapid.. The evolution is uneven.

Patients have a marked disease awareness, and recognize and adequately perceive their limitations. These are poorly experienced. Their mood is usually sad and flattened.

Attention is preserved. The MCP is sometimes diminished, and the MLP is often inexplicably altered. There are no language disturbances.

His behavior is not consistent with the deficit, and this is usually of abandonment. Social impairment appears early.

Symptoms are exaggerated by the patient (more complaints appear than those objectified), and the complaints are specific. In addition, patients respond to medical tests with little cooperation, and success is variable. They are anxious about them. The answers they usually show are global and disinterested (of the "I don't know" type). Failures stand out.

Treatment with antidepressants improves mood, and consequently cognitive symptoms also improve, unlike in dementia, where cognitive symptoms do not improve with antidepressants.

Treatment

Ehe treatment of depressive pseudodementia should focus on the treatment of the depression itself.The treatment of depressive pseudodementia should focus on the treatment of the depression itself, since as the depression improves, the cognitive symptoms improve. Thus, the most complete treatment will be a cognitive-behavioral (or only behavioral) treatment combined with pharmacological treatment.

Behavioral therapy is also indicated, as well as interpersonal therapy or third generation therapies (e.g. Mindfulness).

Yoga or sports also often have beneficial effects in reducing anxious symptoms, which are often associated with depression. In addition, they help to reduce stress, reduce ruminations and sleep better.

Bibliographic references:

• Arango, JC. and Fernández, S. (2003). Depression in Alzheimer's disease. Revista Latinoamericana de Psicología, 35(1), 41-54.
• Belloch, A., Sandín, B. and Ramos, F. (2010). Manual of Psychopathology. Volume II. Madrid: McGraw-Hill.
• Emery, V. O.; Oxman, T. E. (1997). "Depressive dementia: A 'transitional dementia'?". Clinical Neuroscience. 4 (1): 23-30.
• Kral, V. A. (1983). The Relationship between Senile Dementia (Alzheimer Type) and Depression. 28(4). https://doi.org/10.1177/070674378302800414.