QuestionSBA
QuestionChoice
The most common first manifestation of Alzheimer's dementia is short-term memory loss. The disease progresses gradually, with periods of a plateau, and may cause behaviour disorders such as wandering, agitation, and persecutory ideation.
62086
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Alzheimer's dementia
QuestionChoice
Frontotemporal dementia is a type of neurodegenerative disorder that affects intellectual functions such as abstract thinking, reasoning, and executive function, leading to difficulties with activities of daily living. It is characterised by changes in behaviour, dietary habits, empathy, apathy, and executive function and may initially present with intact memory.
62084
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Frontotemporal dementia
QuestionChoice
Normal pressure hydrocephalus causes a classical triad of symptoms: urinary incontinence, dementia and Parkinsonian-like gait abnormality. This is secondary to reduced CSf absorption and is reversible. Whilst this patient has dementia, and is in the right demographic category for this condition, she does not exihibit the other features.
62087
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Normal pressure hydrocephalus
QuestionChoice
Pseudodementia (depressive dementia) is often **short and abrupt in onset**, while dementia is more often gradual. Suspect pseudodementia in older people with predominantly cognitive symptoms (memory loss, prominent slowing of movement, and slowed speech) with a relatively acute onset in whom a major life event has occurred as they are more likely to be suffering from a simultaneous major depressive episode as opposed to true dementia.
62083
a
Pseudodementia
QuestionChoice
Vascular dementia tends to affect executive function earlier and cause memory loss later. It tends to progress in steps, with each episode causing intellectual decline that may be followed by modest recovery. Cognitive loss may be focal, making them more aware of their deficits and more prone to depression.
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Vascular dementia
Concept
Chapter
# Summary

Pseudodementia, a significant differential for dementia, is primarily associated with cognitive deficits in older patients battling depression. Key signs and symptoms include a short duration of dementia and equal effects on both long and short-term memory, with patients often demonstrating amnesia for specific, emotionally charged events. The condition is characterised by early loss of social skills and an overall lack of effort in performing tasks. Investigations focus on comprehensive cognitive assessments and psychiatric evaluations to distinguish it from dementia. Management primarily involves treating the underlying depression and providing cognitive-behavioural therapy.

# Definition

Pseudodementia is a condition primarily associated with cognitive deficits in older patients suffering from depression. It is an important differential of dementia, characterised by cognitive and memory impairments that mimic those of dementia but with an underlying psychiatric cause.


# Aetiology
While the exact cause of pseudodementia is unknown, it is primarily associated with **depression** in older adults. Other psychiatric conditions, such as anxiety disorders, can also contribute to its development.

# Signs and Symptoms

* Short duration of symptoms mimicking dementia
* Equal impact on long-term and short-term memory
* Amnesia concerning specific, often emotionally charged, events
* Detailed complaints about memory disturbances
* Highlighted failures in responses to memory-related questions
* Early loss of social skills in the disease progression
* Common responses of “don't know” to questions, rather than attempting to guess
* Minimal effort in task performance


# Investigations

Investigations into pseudodementia focus on comprehensive cognitive assessments and psychiatric evaluations to differentiate it from dementia. Neuroimaging studies can help rule out organic causes.

# Management

The management of pseudodementia primarily involves treating the underlying depressive disorder, often with a combination of antidepressant medication and cognitive-behavioural therapy. With appropriate treatment, cognitive symptoms usually improve or resolve. In contrast, dementia is a progressive condition with, to date, no curative treatment.
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Pseudo-dementia
Topic
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Geriatrics
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An 80-year-old woman presents with a complaint of forgetfulness for the past three months. She used to live with her husband but has been living alone since his passing two years ago. Recently, she has become increasingly forgetful and socially withdrawn. She contacts her children less frequently than she used to and has been late paying her bills. She blames her recent memory impairment on tiredness. Her medical history includes being treated for depression as a teenager. Her physical examination is unremarkable, and the Mini-Mental State Examination score is 27/30, but she declines to answer some questions and needs to be urged to participate in the assessment.

What is the single most likely diagnosis?
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