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depressive pseudodementia
Epidemiology:
-> 10% of late-onset depression
Clinical manifestations:
1) affective symptoms &/or a history of prior depression
2) discrete course with subacute onset
3) mini-mental status exam > 21 & 'depressed' depression scale
4) patient emphasizes cognitive deficits & disability
5) more comparable* recent & remote memory loss
6) more comparable* impairment of verbal & performance skills
7) normal neurologic examination
8) features of subcortical dementia
a) psychomotor retardation
b) apathy
9) insomnia
10) anorexia
* compared with dementia
Special laboratory:
1) normal P300 scalp-recorded potentials
2) EEG: minor abnormalities in 20%
3) neuropsychologic testing (best discriminitory tests from dementia)
a) delayed retrieval > immediate recall
b) tasks with distraction before retrieval
c) tasks with high capacity demand
d) tasks presenting words or common objects > tasks presenting sentences, digits or geometric designs
Radiology: normal neuroimaging
Management:
1) antidepressants result in improvement rather than delirium
2) diagnostic maneuvers [2]
a) sleep deprivation 36-40 hours may result in transient improvement
b) amobarbital interview
1] marked improvement with pseudodementia
2] all deficits worse with dementia
Related
dementia; Alzheimer's disease & related dementias (ADRD)
General
depression
References
- Comprehensive Geriatric Assessment, Osterweil et al eds,
McGraw Hill, New York, 2000, pg 89
- Smith, R. Jewish Home for the Aging, Reseda CA, 2001