Depressive pseudodementia: symptoms, causes and treatment

Many times, when a person suffers a depressive episode or disorder, their cognitive functions are altered; Thus, it can decrease your ability to concentrate and your memory, for example.

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

• Related article: "Types of depression: its symptoms, causes and characteristics"

What is depressive pseudodementia?

Depressive pseudodementia consists of the presence of dementia symptomatology that also includes the mood alteration typical of depression. That is, the depressive picture is accompanied by a severe cognitive impairment extensive enough to resemble or simulate dementia.

It is true that pseudodementia It does not appear only in depression, but it can appear in other functional psychopathological pictures. However, the most common is depression.

Symptoms

We will see the characteristics (in addition to the depressive ones) in more detail in the differential diagnosis section; however, the most important are:

decreased ability to concentrate, difficulty remembering certain events (impairment of immediate and short-term memory, for example), attention difficulties, etc.

Causes

Depressive pseudodementia appears as a result of depression; many times the patient is suffering a state so negative and apathetic that cognitive functioning is impaired. His psyche is so immersed in this state, as if there is no room for anything else. That is to say, it would be what we commonly call “not having a head at all”.

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

Various explanatory theories have been put forward for this; one of them is that there is a continuum between depression, cognitive alteration and dementia in subjects with Alzheimer's. 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.

• You may be interested in: "Alzheimer's: causes, symptoms, treatment and prevention"

Differential diagnosis: depressive pseudodementia and Alzheimer's

In clinical practice, it is easy to confuse the symptoms of dementia with those of a depressive pseudo-dementia. Therefore, it is important to analyze the differences between one and the other.

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

Alzheimer's dementia: characteristics

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

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

The behavior is consistent with the deficit, and is usually compensatory. Social deterioration is slow. The clinic is also consistent, with nocturnal aggravation, global affectation of yields and imprecise complaints (which are smaller than those objectified).

In medical tests these patients cooperate, and these cause them little anxiety. The results are usually constant. The responses displayed by the patient are often evasive, erroneous, conniving, or persevering.. Successes stand out.

Regarding the response to treatment with antidepressants, the treatment does not reduce the cognitive symptoms (it only improves the depressive symptoms).

Depressive pseudodementia: characteristics

Now let's see the differences between Alzheimer's and depressive pseudodementia. In depressive pseudodementia, all of the above features vary. So, its onset is well defined and its onset is rapid. The evolution is uneven.

Patients have a marked disease awareness, and adequately recognize and perceive their limitations. These are bad experiences. His humor is usually sad and flattened.

attention is preserved. The MCP is sometimes decreased, and the MLP is often inexplicably altered. There are no language disorders.

His behavior is not consistent with the deficit, and this is usually abandonment. Social deterioration 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 with them is variable. These make them anxious. 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 also improves the cognitive symptoms, unlike dementia, where cognitive symptoms do not improve with antidepressants.

Treatment

ANDhe treatment of depressive pseudodementia should focus on the treatment of depression itself, since by improving this, cognitive symptoms improve. Thus, the most complete treatment will be a cognitive-behavioral (or solely behavioral) treatment combined with pharmacological treatment.

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

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

Bibliographic references:

• Arango, JC. and Fernandez, S. (2003). Depression in Alzheimer's disease. Latin American Journal of Psychology, 35(1), 41-54.
• Belloch, A., Sandin, B. and Ramos, F. (2010). Manual of Psychopathology. Volume II. Madrid: McGraw-Hill.
• Emery, v. EITHER.; Oxman, T. AND. (1997). "Depressive dementia: A 'transitional dementia'?". Clinical Neuroscience. 4 (1): 23–30.
• Krall, V. TO. (1983). The Relationship between Senile Dementia (Alzheimer Type) and Depression. 28(4). https://doi.org/10.1177/070674378302800414.