Primary or depressive dementia: Clinical features

desRosiers, Gabriel

doi:10.1002/gps.930070904

Cited by 15 publications

(6 citation statements)

References 96 publications

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“…Accurate differentiation of depression from dementia can be extremely challenging even for experienced clinicians (Mulley, 1986;Lishman, 1987;Desrosiers, 1992). This is not surprising as depression in the elderly is frequently accompanied by impaired cognition or 'pseudodementia' (Jorm, 1986), whereas up to 60% of patients with Alzheimer's disease (AD) show some depressive symptoms (Burns el al.…”

Section: Introductionmentioning

confidence: 99%

“…Wells (1979) proposed a number of clinical features that may be helpful in differentiating pseudodementia from dementia. However, few have been prospectively validated and the reliance that can be placed on these has been questioned (Desrosiers, 1992). The availability of a biological or radiological marker which could assist with differential diagnosis would be a major advance.…”

Section: Introductionmentioning

confidence: 99%

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The differentiation of depression from dementia by temporal lobe magnetic resonance imaging

et al. 1994

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SynopsisTemporal lobe Magnetic Resonance Imaging (MRI) was performed in 43 patients with NINCDS/ADRDA Alzheimer's disease (AD) (33 probable, 7 possible, 3 definite) and 32 subjects with DSM-III-R Major Depression (DEP) matched for age, sex and level of education. Hippocampus (anterior and posterior, right and left), amygdala, entorhinal cortex, para-hippocampal gyrus and cerebral cortex were rated for atrophy on a 4-point scale. Good discrimination between groups could be achieved using a cut-off of 2 or more on anterior hippocampal atrophy rating (sensitivity 93%; specificity 84%; 89% cases correctly grouped overall). Even among a subgroup of 9 mild AD subjects and 10 cognitively impaired DEP subjects (matched on mini-mental state score), the same cut-off correctly grouped 84% (16/19) cases. Hippocampal atrophy increased with age in both AD and DEP subjects leading to a reduction in specificity (but not sensitivity) for those aged over 75. Within the AD group a significant correlation was observed between length of history and atrophy of the entorhinal cortex (r = 0·39, P = 0·009). We conclude that temporal lobe atrophy on MRI can provide good discrimination between AD and DEP subjects, including those DEP patients with cognitive impairment apparent on screening tests of cognitive function.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The differentiation of depression from dementia by temporal lobe magnetic resonance imaging

et al. 1994

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“…This leaves the third controversial issue (measurable versus unmeasurable cognitive problems) unresolved, resulting in the term`pseudodementia' encompassing two categories of patients (Ballard et al, 1996). The ®rst group was those who often have subjective memory complaints without true intellectual de®cits and give`I don't know' responses during cognitive assessment (eg Wells 1979;Desrosiers, 1992). The second group comprised those who make eorts to participate in cognitive testing but despite this show performance de®cits during cognitive assessments (eg Folstein and McHugh, 1978;Massman et al, 1992).…”

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confidence: 99%

“…Wells' proposed discriminating features suggested that some attributes (eg personal vs instrumental competence, complaint vs performance) might provide valuable pointers of the conditions whereas others (eg history of depression) remain more controversial. The greatest obstacle at this stage is that practically none of the proposed discriminating features in the literature has been validated through prospective studies (Desrosiers, 1992).…”

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confidence: 99%

A preliminary report: a new scale to identify the pseudodementia syndrome

Yousef

Ryan

Lambert³

et al. 1998

Int. J. Geriat. Psychiatry

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Background. The literature was reviewed to abstract items which were claimed to distinguish organic dementia from pseudodementia. Their discriminating powers were tested in a prospective study. Eighteen of these items were selected to create a questionnaire which should distinguish organic dementia from pseudodementia. The gold standard was the final diagnosis given by a consultant psychiatrist 12–14 months later. Method. One hundred and twenty‐eight patients referred to our service with a differential diagnosis of depressive pseudodementia were screened using a checklist of 44 characteristic features (in the form of questions with ‘yes’ or ‘no’ answers) which were claimed in the literature to differentiate between organic dementia and depressive pseudodementia. This checklist covers the areas of history, clinical data, insight and performance. Results. Forty points (questions) out of the 44 in the checklist showed significant discriminating power to differentiate dementia from depressive pseudodementia (p<0·01). A principal component and factor analysis was performed from which 18 questions were extracted. The shortened questionnaire was able to classify (43/44 cases) 98% of dementia cases and (60/63) 95% of depression correctly. A new definition has been introduced for ‘pseudodementia’ as a syndrome of reversible subjective or objective cognitive problems caused by non‐organic disorder. Thus depressive pseudodementia may be classified into two subtypes. Type I is a group of patients who have depressive symptoms with subject complaint of dysmnesia without measurable intellectual deficits. Type II is a group of patients who have depressive symptoms and show poor cognitive performance based on poor concentration not due to organic disorder. © 1998 John Wiley & Sons, Ltd.

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“…Partly responsible for this confusion are the current difficulties in defining the concept of ‘primary dementia’ in its earliest stage.4 With no antemortem biological marker for Alzheimer's disease (AD), we must still fall back on behavioral (e.g., memory decline) and operational (e.g., symptom threshold) concepts to detect the earliest features of dementia associated with AD 5–7 . Thus, ambiguities arise in relation to ‘non‐harbinger’ concepts of cognitive attenuation such as ‘benign senescent forgetfulness’ or ‘age‐associated memory impairment’ 8–11 .…”

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confidence: 99%

The Neuropsychological Differentiation of Patients with Very Mild Alzheimer's Disease and/or Major Depression

desRosiers

Hodges²,

Berríos³

1995

J American Geriatrics Society

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As efforts intensify to develop more powerful means to identify patients with Alzheimer's disease in its earliest stages, inclusion of specialist tests posing greater cognitive challenge than standard mental status scales has been one strategy. Our study explored how some of these neuropsychological tools behave psychometrically when analyzed on a single-case basis, and the results suggest a few are sensitive enough to boost detection above base rates alone while also being specific enough to reduce false alarms. Retention on Wechsler's Logical Memory and Visual Reproduction tasks and scores on Kendrick's Object Learning Test helped decrease the degree of ambiguity when cognitive profiles were used to distinguish depressed patients with Alzheimer disease from those without.

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Primary or depressive dementia: Clinical features

Cited by 15 publications

References 96 publications

The differentiation of depression from dementia by temporal lobe magnetic resonance imaging

The differentiation of depression from dementia by temporal lobe magnetic resonance imaging

A preliminary report: a new scale to identify the pseudodementia syndrome

The Neuropsychological Differentiation of Patients with Very Mild Alzheimer's Disease and/or Major Depression

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