Differential Diagnosis of Depression and Dementia

Abstract

Cognitive complaints and depressive symptoms are common in older adults. While depressive symptoms may represent a primary mood disorder, they may also refl ect the early signs of a dementia. Depression and dementia often differ in terms of their cognitive profi le as well as the phenomenology of the depressive symptoms. Neuropsychologists can play an important role in making diagnostic decisions by providing objective assessment of both cognitive and psychological functioning. This chapter reviews considerations for differential diagnosis and provides practical tips for the clinician.

The Role of Baseline Cognitive Function in the Neurocognitive Effects of Electroconvulsive Therapy in Depressed Elderly Patients

“…Early observations of marked cognitive side effects of ECT may have an impact on the choice of treatment parameters and on decisions to terminate treatment. The benefits of including routine clinical neuropsychological evaluations in the context of elderly patients referred for ECT include even potential differential diagnostic contributions (Bieliauskas & Drag, 2013) and the provision of useful background information for the tailoring of further multidisciplinary follow-up aimed at preventing the relapse of depression.…”

“…CIND is a heterogeneous classification which includes nondemented elderly people who exhibit poor performance on a cognitive measure on a specific point of time (Schoenberg & Duff, 2011;Tuokko & Frerichs, 2000, Tuokko et al, 2003. Elderly patients with longstanding histories of major depression and cerebrovascular disease often demonstrate cognitive impairment (Bieliauskas & Drag, 2013;Butters et al, 2008). Also, the frontostriatal abnormalities and preclinical stages of age-associated neurological disorders such as Alzheimer's disease increase the risk of depression in the elderly (Butters et al, 2008).…”

Alzheimer’s disease

“…The behavioural variant of frontotemporal dementia can be differentiated based on the primacy of personality and behavioural changes, and executive dysfunction, but otherwise relatively preserved cognition (Rascovsky et al, 2011). Depression may be indicated by more acute onset, cognitive concerns out of proportion to performance, dysphoric mood and loss of self-esteem, along with a cognitive profile of difficulties with effortful processing, diminished effort, reduced processing speed, attention, and executive functions, and a retrieval memory profile (Bieliauskas & Drag, 2013).…”

Treating comorbidities in dementia: Depression.

“…Depression is represented as a frontal-subcortical pattern, which causes executive functioning deficits than can influence cognition in other domains. The cognitive profile of AD is cortical in nature and characterized by prominent memory disturbance and additional deficits in language and praxis (Bieliauskas & Drag, 2013).…”

“…Depression and dementia share common symptoms that can complicate accurate diagnosis of depression in individuals with dementia (Ballard et al, 1996;Novais & Starkstein, 2015). In addition, late-life depression can be accompanied by significant cognitive impairment that can be misdiagnosed as dementia (Bieliauskas & Drag, 2013). Depression-related cognitive symptoms have historically been referred to as pseudodementia and represent a reversible cause for dementia, in that the depression-related cognitive changes resolve or greatly improve once the depression has been treated.…”