Distinguishing between depression and dementia in the elderly: A review of neuropsychological findings

Abstract

Distinguishing between cognitive deficits seen in depression and progressive dementing, diseases is complex and often difficult clinically. We review recent neuropsychological studies comparing normal elderly individuals, depressed patients, and patients with progressive dementias. Findings from these studies suggest that the distinction between depression and dementia is fairly straightforward and facilitated by neuropsychological evaluation. Data from neuroimaging studies of depressed elderly are reviewed and integrated with the neuropsychological findings. A descriptive scheme for categorizing elderly patients is proposed. It is suggested that the label "pseudodementia" be discarded in favor of more thorough description of cognitive deficits associated with various clinical presentations.

Ageism in Mental Health Assessment and Treatment of Older Adults

“…Scholars have written extensively on "pseudo-dementia," a clinical presentation of depression distinguished by cognitive decline as the hallmark complaint (Burns and Jolley 2015). This syndrome is more common among older adults compared to younger adults, and assessment may be complicated by the presence of changes in cognition due to normal ageing or medication effects -both frequent among elderly patients (Lamberty and Bieliauskas 1993). In the case of pseudodementia, an emphasis by a clinician solely on the presentation of cognitive deterioration may reflect an ageist assumption that dementia is an unavoidable part of old age.…”

Pseudodementia: A slow death

“…These included "dementia syndrome of depression" (Folstein and Mchugh, 1978), "depression induced organic mental disorder" (McAllister, 1983), "four ideal types of depression and dementia syndromes" (Feinberg and Goodman, 1984), and "depression related cognitive dysfunction" (Stoudemire et aL, 1989). Other descriptive papers on pseudodementia were published describing, in varying degrees, the cluster of symptoms that characterize its clinical presentation, reversibility, clinical correlates, and differential from Alzheimer's disease (AD; Benedict and Nacoste, 1990;Caine, 1981, Caine, 1986Cummings, 1989;Kaszniak, 1987;Lamberty and Bieliauskas, 1993;McAllister, 1983). Most of this research attempted to clarify the appropriate clinical use of the term, its differential from AD, and the need for therapeutic intervention.…”

“…There have been several critical reviews of the existence and clinical use of the term pseudodementia (Arie, 1983;Feinberg and Goodman, 1984;Lamberty and Bieliauskas, 1993;Post, 1975;Reifler, 1982;Shraberg, 1978;Shraberg, 1980). While these authors have agreed that the term pseudodementia alerts clinicians to a potentially treatable form of cognitive impairment, they have argued for the abandonment of the term for the following reasons: (1) the term implies that the patient has either an organic or a functional illness when many patients present with both, (2) the term is often mistakenly used as a diagnosis when it was intended to be a descriptive label only, (3) the term confuses the complicated interaction of depression and the aging brain, (4) the term oversimplifies the division between cognitive and affective illness, (5) the term does not clarify the relation between degenerative neurophysiological changes in aging and depression, (6) the term does not address questions regarding the clinical response of depression to antidepressant medication in patients with irreversible dementia, (7) the term does not elucidate the association between dementia and depression, and (8) the term itself does not specify the etiology of the presenting symptom cluster.…”

“…Indeed, some have argued that the term pseudodementia has been misused, poorly understood, and lacks etiological conceptualization (Lamberty and Bieliauskas, 1993;Shraberg, 1980). Indeed, many questions remain unanswered and the evolution of the concept pseudodementia will likely continue.…”

“…Recently a conceptual model was proposed that addresses the multiple problems associated with the current use of the term pseudodementia (Lamberty and Bieliauskas, 1993). The model categorizes older adults based on cognitive function, affective symptoms, and neuroimaging (magnetic resonance imaging/computed tomography) findings.…”