Depression pseudodementia

In differentiating depressive pseudodementia from primary degenerative dementia with secondary depression Transcranial Magnetic Stimulation... 

Hypothyroidism can result in depression, pseudodementia and, in severe cases, myxedema coma. Conversely, it can also lead to inappropriate euphoria, depression and frank psychosis (Lichtenstein, 1980). Other higher center problems include sensorineural deafness, and the mechanism is thought to be due to the deposition of gly-cosamino glycan and bone hypertrophy, but this can be difficult to confirm. Severe hypothyroidism can result in severe mental retardation (cretinism) in children. Grandmal seizure is not uncommon. It is thought to be due to the failure to excrete water, resulting in severe hyponatremia and occurs in about 25% of cases (Myers and Hays, 1975). 

Dementia. In the elderly, you may have difficulty distinguishing depression from the early stages of dementia. Depressed patients often report memory problems and may even ask, Do 1 have Alzheimer s disease It is usually not that their memory itself is impaired. Their forgetfulness is more the result of apathy and poor concentration that leads them to overlook the things going on around them. The result is a false dementia or pseudodementia. On the other hand, patients with true dementia often become depressed as well. 

Despite these clues, a definitive diagnosis often cannot be made. In that case, a prudent course is to treat what would be treatable. The initial evaluation should carefully look for treatable medical causes of dementia or depression. These include vitamin deficiency and hypothyroidism among others. If no medical causes are found, then treatment for depression should be started. If the patient is depressed and suffering from a pseudodementia, the patient can expect full recovery of memory as the depression resolves. But if the patient has a progressive dementia such as Alzheimer s disease, then treatment for depression has done no harm and may still provide some benefit. 

Not surprisingly, it is often difficnlt to distinguish depression with pseudodementia from dementia with depressed mood. Generally, patients with dementia will try to answer yonr qnestions but will make mistakes whereas patients with pseudodementia will more likely say, I don t know. This distinction is not, however, totally reliable. 

Many times the best diagnostic approach is to treat what is most easily treatable. In this case, that is the depression. Once the depression has been treated, the presence of a dementia can be reassessed. The improvement in cognitive function in depressed patients with pseudodementia after successful antidepressant treatment is impressive. 

Miscellaneous Vasculitis/inflammatory Sarcoidosis/porphyria Dementia pugilistica (recurrent head trauma) Parkinson s disease/Huntington s disease Pseudodementia of depression Diagnosis and treatment varies... 

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