Reversible Cognitive Disorder - Pseudodementia

A primary reason that accurate diagnosis is so important among people exhibiting cognitive problems is that some causes of cognitive impairment are reversible. Consider the costs - physically, emotionally, and financially - of diagnosing someone with irreversible dementia when, in fact, the problem could have been reversed. Reversible conditions creating cognitive problems include pseudodementia, medical conditions, and delirium.

Pseudodementia

Pseudodementia is a situation where a person who has depression also has cognitive impairment that looks like dementia. Depression is a mental disorder that includes a depressed mood that lasts at least two weeks accompanied by the loss of interest or pleasure in nearly all activities, feelings of guilt or suicidality, social withdrawal, and sleep and appetite disturbances. Depression can also create cognitive symptoms such as difficulty thinking clearly, problems concentrating, and difficulty making decisions. For more detailed information about the symptoms of depression, please click here to visit our associated topic center. Pseudodementia is not permanent; once a person's depression is successfully treated, his or her cognitive symptoms will go away as well.

Diagnosis

Estimates suggest that between 2% and 32% of older individuals who experience cognitive problems actually have pseudodementia. However, this number may not be completely accurate, because it is often tricky to distinguish between depression and dementia in older adults. A thorough clinical interview can reveal important clues about the proper diagnosis. For instance, while people with depression may complain of having memory problems and appear upset about them, they will usually perform well on objective neuropsychological tests of memory administered in a clinician's office. On the other hand, individuals with dementia will often deny having any problems with memory or minimize their importance, and display impairment on neuropsychological tests.

The Geriatric Depression Scale (GDS) (described in an earlier section;click here to return to that discussion) is often used to help differentiate between pseudodementia and other forms of dementia. Results from the GDS are combined other information about a person's history and current functioning to help with diagnosis. For example, people with pseudodementia typically do not have a history of mood swings (unless they have Bipolar Disorder, an illness characterized by repetitive swings in mood and energy levels) and are likely to score high (high = more depressed) on the GDS. In contrast, people with dementia usually show a range of emotions, sometimes responding to situations with an inappropriate emotion (e.g., laughing while others are sad).

Treatment

Although pseudodementia is reversible, treating it can be as complex as treating "regular dementia," requiring a flexible approach and multiple treatment modalities (e.g., medication, psychotherapy, or a combination of both). Depression has multiple potential causes (click here to read more about causes of depression in our related topic center); therefore, which treatments or combinations of treatments will be effective tend to vary across individuals.

Medications to treat depression include monoamine oxidase inhibitors and trycyclics, which make neurotransmitters (chemical messengers in the brain and nervous system) that impact mood such as norepinephrine and serotonin more readily available in the brain. Another class of medications called selective serotonin reuptake inhibitors (e.g., Prozac, Paxil) raises the overall level of the neurotransmitter serotonin. Each of these types of medications has different potential side effects and should be used in consultation with a health care professional who has specific expertise in treating depression.

Psychotherapy involves meeting with a licensed mental health care professional, either individually or in a group, and working on strategies to help manage or reduce depressive symptoms. Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are two types of therapies for depression that have been shown to be successful in research studies. CBT involves modifying a person's behavior and thinking patterns that are contributing to a depressed mood. IPT focuses on understanding how personal relationships can cause someone to become depressed or make already existing depressive symptoms worse. For more information about depression and the different treatment options available, please see our related topic center.

Depression is often successfully treated; however, symptoms (including cognitive impairment) typically do not go away immediately. Both medications and psychotherapy techniques may require several weeks before providing a noticeable decrease in symptoms. In addition, people who have depression may experience relapses (i.e., symptoms return). It is important to find a qualified mental health professional to treat and monitor depressive symptoms across time.

Comments
  • angela

    if you have been diagnosed with this how is it effecting you?

  • Janet

    My fathers condition has left me frustrated and emotional, however after looking at pseudodementia feel I can work in a positive way with regular medication, food supplements (Bcomplex vitamins and trace elements and EFAs - he has not been eating properly), interhemispheric integration exercises such as brain gym - I feel that there is some sensory integration/processing delay and relaxation/hypnotherapy CD sessions. Any one else tried multi approach?

  • T.A.M.

    I have a preliminary diagnosis of pseudo dimentia. I am male, sixty three and glad to hear of the potential link to depression. As to how I am effected by pseudo dimentia, I would rather have a broken bone. Normally I am a very happy and outgoing guy, but not at the moment. I have bad dreams, don't want to put forth the effort to be with others, hate any type of competion, have no energy, am frustrated by numbers and occasionally get confused. I feel that sex is not worth the effort. Imagine being three feet under water and you just can't reach the surface, That is what my black hole of depression looks like. Yes, I can usually function reasonably well if not under pressure. However, add pressure and and I want to strike out at someone or something, withdraw from the confusion, run away from the darkness...

  • amauta

    I wrote this comment re Washington Post article on risks of hormone replacement therapy. Applies to this discussion:

    Mine is not the type of testimonial doctors want to hear for I am a determined long-time HRT participant. My reasons for continuing to use it fly in the face of all the warnings against it. I've been on HRT (estrace daily + progesterone 10 days/month) for 19 years starting when I was 53 while going through menopause. I had typical menopause symptoms. Mostly I took it to prevent osteoporosis.
    The menopause symptoms went away dramatically. Most surprisingly and totally unexpected was the return of my short-term memory. I'd been coping with this very diminished capacity for some time and was distraught for I believed I was suffering from dementia. My memory loss was significant and incapacitating (in my early 50s!): I could not carry on an ordinary conversation without writing down what the other person was saying so that I could refer to my notes to respond. Ditto telephone conversations--reams of paper with my jottings. I couldn't remember people's names--life-time friends! Couldn't tell you what the movie I just saw was about or what the book I was reading or had just read was about. I attributed my memory loss to aging. (Fairly recently my doctor told me it was not dementia but "pseudo dementia.") Within a week of starting to take estrace (estradiol), I noticed a remarkable improvement in my short- term memory. It was HUGE and took me by surprise cuz I wasn't expecting it. I mentioned this to my family doctor who said that the connection of HRT to improvement in memory was anecdotal--that it hadn't been verified by scientific testing (it since has been). I said anecdotal or not, it was REAL for me. It improved the quality of my life immeasurably.The remarkable recent develpment is that my over-all memory has IMPROVED during the last 2 years or so. I'm sharper mentally than I ever was! I wonder if this would qualify as an "anecdotal" response to long-term use of estrace.There is no way I would give it up and revert to dementia, pseudo or real...the other health risks notwithstanding. It'd be like shuting down half of my brain.
    In ref to the risks of HRT: I too feel the culprit is progesterone, especially in combination with "conjugated" estrogen (primarin) which is the combination they've tested to come up with the risks. HRT gave me back my life.....I ain't quiting!

  • Anonymous-1

    I was elated to have a name for his condition I have been experiencing for some time now. Never in a million years would I have paired loss of memory with depression. I've been experiencing depletion of my lexicon. And when I look up words in the dictionary, I have to revert back to definitions often. If I read an item multiple times, cognitively, feels like a new read with each attempt. My job is very intellectually and thus extremely difficult....so much energy expended in the process of understanding for me these days but after reading this article, I'm more hopeful.

    Per your article, treating depression and pseudo dementia can be tricky. Finding the right blend of therapy and medication is key. I am seriously contemplating participation in research that combines an antidepressant with an ADHD medication to see if this will speed up cognitive healing. Serotonin Syndrome (too much serotonin reaction from drug combo) is a moderate concern, but I am educating myself on warning signs of this condition so I can immediately report symptoms to the doctor.

    I'm so happy to know that this condition is reversible!!

  • sally

    My memory loss has been put down to psuedodemensia and is frightening me enough that at the age of 56 I am thinking I should start making a will and clearing away years of theraputic writings that I wouldnt want any one to see. Writing daily has been the only way I could express freely where no actual person socially or proffessionally existed for me who had proper understanding of my long term mental situation and the depressive complications I have experienced for years. Unfortunately although writing would likely still be useful, even that doesn't seem worth the effort anymore, I have lost all motivation for self help. For every one or two steps hard acheived to move forward, I fall two or more back again every time. It's always the same old story and you can get sick of yourself and your difficulties. I think being tired of yourself is why death can become a preoccupation with depressed people. It an end to living death. Some people seem to be diagnosed and get better easier than others. Personally I deteriorate inside at a rate of knots even while perhaps improving to all outward appearances.

  • Anonymous-2

    I was dignosed with Pseudodementia in 2013. I hate it

    It is almost like one more thing that doesn't exsist. It is but it isn't. I am a 52 yr old female. I have been dignosed with Fibromyalgia for several years. But slowly I was working less and less. I actually was a cashire I just lost my job because after 18 yrs of doing it I could no longer remember how. When I rang up and customers grocerys gave her the change and rerang the grocerys once more I knew there was a problem as did my boss. I had several test done and they came to the conclussion I have Pseudomentia. I have had depression for several years and tried differant medications. They say this is reversable but I would like to know how one does so? I have had a lot of pain and loss in my life thoughout the years. 2011 my mother had a massive stroke and ended up in a nursing home. My 53 yr old sister unespecialy died and 6 months same yr my 52 yr old sister died. Afew months later I moved mother to a nursing home closer to me. She has Vasculer Demtia along with a huge list of other things. I was seeing a Mental Doctor and I am on 80 mg of prozac & 100 mg of Welbutrin which isn't helping if anything I find my self getting more angry. I see a sleep specialist for sleep apnea and Exsecive day time sleepyness. I take 60 mg XR Adderal a day both for ADHD and E.D.S. and 10 mg ambien to go to bed at night along with 2 xanax one for morning and one at night. The last few months I have been exsperancing bumping into walls and tripping over my own feet. This year alone I have had 3 MRI because the neruoligist said something was defianitly wrong. My reflexes were brisk and I don't walk right can't do the tippy toe thing or walk on heals feet. She told me to get a cane. The only thing that showed up on the MRI was legions on the brain which compared to an MRI 5 yrs ago there are now more. But in the wrong spot to be MS or anything else. They did find a little autheritis in the neck. Her conclussion after thousands of $$$$ was I might want to go somewhere and learn how to walk. !! (I am not kidding) so now I am still sick and have no job couldn't work any way because I wouldn't remember what I am doing. I applied for disability but because Psuedodemtia is suppose to be reversable and Fibromyalgia can't be proved I feel that I have very little to go on.

    I would like to know if anyone else is dealing with this and they have aplied for disability and won? .The good and bad is I do have insurance but have to pay a lot for my deductable and if they put me on Medicade there is not a doctoer around that excepts it. :( Thank you. For any information

  • kk

    In 2006 I was diagnosed with Early Onset Parkinsons Disease. In 2010 the diagnosis was expanded to be EOPD accompanied by Lewy Body Dementia.

    Recently, after a series of falls, a specialist at Beth Israel Hospital in Boston, MA told me that there was a strong possibility that I dont have Parkinsons. As one of the possibilities, he suggested Pseudo-dementia.

    I struggle with depression constantly. I have done since I was a small child. I am prone to being very hard on myself and I know that I am often treating myself unfairly...but when I heard the doctor say "pseudo-dementia" I felt completely at a loss. I know the brain can create functional change that feels and looks "real" but it makes me feel as if I'm making something up when I swear that I'm not.

    I just found out the doctors opinions today. Just a few hours ago, in fact. I feel like a fraud...as if I'm crazy...and I dont know what to do.

  • JH

    I failed out of a very competitive school program because of pseudodementia. There were days where I couldn't remember how to write my name on a test. And of course, since that level of depression prevents one from making good decisions, I couldn't make myself defer. I just tried to work through it. Mentally, I'm much better after a change in medication and a year and a half of therapy. But I'm having a hard time getting back into the schooling. It's frustrating, because if I'd failed out because of cancer or something like that, they'd have let me back in.

  • Anonymous-3

    In reading the comments related to this article, I found one of particular interest. I can identify with the comments dated April 2013. It was like reading my thoughts. That is almost exactly what I have been experiencing. Such as the loss of memory, and reading something multiple times. Also having to look to a dictionary for spelling, and feeling as though I had dimished intelligence.

  • deb wilkin

    I have to beg to differ with you guys and am really concerned about Sally- sometimes is IS DEMENTIA- and if it is- and your able to get (not a favor) a pseduodementia dx- you fail to treat the dementia. I would say there is no reason not to always also treat potential depression (i.e. put patient on SSRI and send them for psychotherapy for a 6-month periods- they will need it either way)- but goodness sakes if it IS dementia it must be addressed. I am going through this with my sister- omg- what a nightmare- neuropsychologist and neurologist were ridiculous- thank goodness for a wonderful clinical psychologist gerontological therapist and a PCP with brains- they were able to give her the CORRECT dx- despite these "pseudo-professionals" trying to be do-gooders ("I just don't want to take away her hope") and allow her the TREATMENT and respect she deserved. I wish Sally will contact me- I will help her.

  • Marlyn

    In having been diagnosed, with severe depression, seasonal affect disorder & Alzheimer's Disease (which, my Mom had for 10 years, until dying from complications due to AD) I think my sons, people who love & care about me, had zero hope for my recovery at all.

    The odd thing is that upon seeing me 2 months after my discharge from the last hospital (had been in 5 different ones on/off for 5.5 months) into the care of my sister & her husband (& my doctor informing them what they ought not let me do because of the AD) my doctor told my eldest son & me, that I didn't have AD. Which he admitted that he had misdiagnosed me with. He hadn't recognized me, the woman sitting in his waiting room. Until, he called me in & looked at me curiously, then asked me how I was doing (which, I felt great & told him so & what I was doing in & with my life). He apologized profusely to my son & me for misdiagnosing me. And, each time I saw him thereafter.

    What I didn't ask him was what instruments did he use to determine this diagnose? Which, clearly the article above indicates. Yet, I was troubled, with the fact that I couldn't recall those 5.5 months of my life (& still don't)? Which, he said that EST would present 2-3 weeks of prior memory loss after the EST, but not 5.5 months.

    Does each EST stand alone, or is there an accumulative affect 2-3 weeks prior memory loss for each treatment? Which, EST I didn't know I had, until that 1st appointment with him. If so, that would equate to 12-18 weeks of memory loss, not 5.5 months. When he encapsulated to me the findings of all the phsyicians at the 4 prior hospital stays & his findings at his, the last one I was very puzzled, frightened & sad that I couldn't remember anything from November 1,2012-May 18, 2013.(Which, I got up out of bed, showered & found clothes that looked like mine, combed my wet hair & put into a bun). Last thing, I remember, on October 31, 3012 was calling my youngest son for his birthday & then on May 18, 2014, waking up in a hospital bed & not knowing how I arrved there, or why. Nor, anything in between.

    The troubling thing is that when I went out to the nurses station & announced who I was & asked why I was there - 1 nurse looked at me like a deer in headlights & the other quickly called someone, which I assumed was my doctor. Though, I asked to talk to him, or for him to see me - he never came & for 5 weeks. Nor, did they tell me what brought me there.Then discharged to my sister & her husband. Stayed there for 2 weeks & insisted that I return home. Now, informed by his messaging service that he would no longer being practicing & indeifnately. Which, kind of disturbed me. No one in his office called me to tell me that my appointment had been cancelled.

    Ironically, I had called his office, that day to reschedule. Had been diagnosed with bacterial pneumonia & didn't think I ought to be in a waiting room - not healthy for others, or for me & since my immune system is compromised already. Called my doctors cell phone, going on the assumption, that he had depression, since that was what the phone message service attendant told me. Called my doctor to offer him support & to take better care of himself & that's when he told me that he wasn't depressed * his license had been revoked, due to 'integrity issues.' He wouldn't, or couldn't explain to me what that meant? And, he had lost 30 lbs & closed 3 of his 4 practices prior to his license being revoked. There'd be a hearing & he wanted me to write a letter of recommednation to the court. Which, I refused to do until I talked to his attorneys. After all, had seen him several times, prior to this call & not knowing he was in trouble in any way. Know, integrity means & I live this way in my life.

    So, I searched the Net & found what behaviors constituted psychiatrist, or mental health counselors 'integrity issues.' He hadn't had sex with me, to my knowledge in the hosppital. Plus, I wouldn't let anyone near me, or take a shower during my hospital stays & smelled to high heaven. Was uncommunicative & stared into space. Wouldn't eat & to my knowldge was void of any emotion, seemingly confused. Don't remember my actions, which caused me to be taken to the 1st hospital, or any thereafter. Don't remember being at my son's home for Xmas brunch, or that I ate an omelet. Don't remember if I had bought any presents for anyone for Xmas. Don't remember my youngest son visiting with me 2 x's from WA. Don't remember, my daugter in law, or neice 2 x's calling medics/police to take me to hospitals during any of this time.

    Didn't want to ruminate on this, instead through therapy, described what I had been feeling prior to my break with reality - & discovered that during 4 years of critical losses & mistreament had buried it all deeply inside. Heck, I didn't know I had burried anything inside. Was living in a safe & cute apartment in a town I love helping to take care of my infant twin grandbabies, had a job caring for my niece's infant & toldler. To me, all was right in the world & mine. I was tired, but that to me was reasonable as taking care of little ones, is exhausting & draining.

    Through, therapy, I'm back to good health & very active. Yet, I need to do take time to rest & sleep well. Eat healithy & walk outside & enjoy things in the community. But, also to feel safe in telling people I love & care about & they me what I'm thinking & feeling & if & when anything is bothering me. I'm making inroads in my recovery. Have a new psychiatrist & therapist, both holistic in their approach, which is very attractive to me & in my best health & wellbeing.

    My former, doctor, haven't heard from him, yet told him when I talked to him last that only 3 people would ever have permission & access to my mental, or phsycial health physicians, or records, or make devisons for my care, which I thought he he duley noted on my records. Yet, he hasn't sent copies of his records to me & it's been a month. Plus, I need to gain records of all the hospitals & other physicians records who attended to me. Which, has been frustrating & time consuming. Ugh!

    Yet, I'm handling it, instead of becoming anxious. When the medical/hospital bills have come in - I've pieced some of the puzzle pieces together - but the dates, hospitals, physicians I don't recall at all. But, I won't linger there it's unhealthy for me to do so. My former doctor, perhaps, was incapicated committed Medicare, or Medicaid fraud, or over charged his clients, or doctored the bills? Or, wasn't attending properly, or appropriately with his treatment, & in my case a misdiagnose. Or, has a drug, or alcohol addiction. Or, not prescribing appropriate medication to his patients. Or, biling the system for drugs from phamecutical companies, or by overcharging his patients. None, of which I nnow know are integrity issues.

    What still is upsetting to me, is that when he took down my sons' & neice's phone #s. He left a message for my eldest son, telling him that he was so concerned about my mental & overall health. And, I ought to get treated ASAP, which was puzzling to me. Since, he said how great I sounded & was proud that I was living my life in good health, productive & doing things I's passionate about doing. BL-call I can determine, is that he was upset that I wouldn't make an appointent with one of his colleagues in his remaining office but elected to tell him I'd look for another psychiatrist nearer to where I live. This in itself reeks of no-integrity, along with the fact that he's not forward copies of his records for me,, which is also lacking intergrity as determined by the governing board. Can you give me some insight for why I can't remember anything for 5.5 months? If not, I won't ruminate on it. Just know, that I don't want to lose time, in my life for any reason.

  • Kitty Berk

    I am 27 years old and I have been diagnosed with pseudodementia, among many other things. I was asked what I did last weekend, by a friend and for the life of me I couldn't recall one single detail. When I tried to really think as hard as I could, my memory is sadly completely blank. I can't remember anything about anything anymore. I feel like I'm walking around in the Twilight Zone. It sadly makes me cry all the time, I don't know sh*t and if I did I can't remember sh*t.

  • Anonymous-4

    I was diagnosed with pseudodementia on 12.02.2015

    Its a struggle everyday

    I try i try hard everyday.

    I forget things ..and it gets hard ..and frustrating because you cant do the things you once could .it's a constant struggle

    My exams are near ... its my first priority and I dont know what to do

    I havr been put on anti-depressants

  • Steve M.

    It is very frustrating just getting through an average day. One moment I seem as smart as a whip and as clear as day. The next moment I am repeating questions I just asked, or trying to figure out why I am so lost. My wife gets very frustrated with me and I get very upset just trying to get through the moment.