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Some aspects of memory disorders clearly distinguish dementia of the Alzheimer's type from depressive pseudo-dementia.

Two groups of patients affected by mild dementia of the Alzheimer's type (n = 42) or by depressive pseudo-dementia (n = 26) were given a modified version of the Rey's Auditory Verbal Learning Test. The two groups were roughly matched for overall level of cognitive impairment. The main purpose of the research was to determine if some aspects of their memory disorders distinguished the two diagnostic groups. Comparison between results obtained on recall and on recognition measures was of little diagnostic usefulness in distinguishing dementia of the Alzheimer's type (DAT) from depressive pseudo-dementia (DPD). A marked prevalence of the recency over the primary effect in immediate recall, a high rate of forgetting, and the presence of many intrusion errors on delayed recall were observed more frequently in DAT than in DPD patients. None of these indices, however, was sensitive and specific enough to allow a confident diagnostic discrimination at the individual case level. The memory measure which best distinguished DAT from DPD patients was the presence of several false positive errors on delayed recognition because DAT patients adopted a very liberal response bias, endorsing many false recognition errors, whereas DPD patients adopted a conservative criterion and tended to miss real stimuli, rather than making false recognition errors.

Aged↗

Sensitivity and specificity of some neuropsychological markers of Alzheimer dementia.

A standardized neuropsychological test battery was administered to 167 patients with different forms of mild-to-moderate dementia: probable Alzheimer dementia (AD: n = 49), multi-infarct dementia (n = 43), idiopathic Parkinson disease with dementia (n = 35), depressive pseudodementia (n = 26), and progressive supranuclear palsy (n = 14). Results obtained were used (a) to analyze the profiles of cognitive impairment shown by the different dementia groups; (b) to assess the incidence of some neuropsychological patterns that we hypothesized to be more characteristic of AD, in the various groups; and hence (c) to evaluate the reliability of these patterns as diagnostic markers of AD. Four of the patterns investigated were derived from a verbal learning task (Rey's Auditory Verbal Learning test): (1) absence of the primacy effect; (2) tendency to produce intrusion errors during free recall of a word list; (3) absolute decay of memory trace; and (4) tendency to produce false alarms during delayed recognition of the same word list. Two additional patterns were derived from visual-spatial tasks (copying drawings and Raven's Coloured Progressive Matrices): (5) occurrence of the closing-in phenomenon in copying drawings; and (6) tendency to choose globalistic or odd responses in Raven's matrices. Though all the six patterns were somewhat useful for identifying AD patients, no pattern met the criteria of being both highly sensitive and highly specific, which should characterize an ideal marker. In fact, intrusions and false alarms were observed in many AD patients, but also in patients affected by other forms of dementia. The absence of the primacy effect, the closing-in phenomenon, and the absolute decay of memory trace were more specific, but could be observed in only one-third of AD patients. We also computed the number of positive patterns shown by each patient and assumed the presence of two or more patterns as a global index suggestive of a dementia of the Alzheimer type. With this cumulative method, a higher level of sensitivity and specificity was achieved in the identification of AD patients.

Aged↗

The differential diagnosis of dementia.

Contrary to prevailing medical belief, dementia is generally not caused by arteriosclerosis of cerebral vessels. There may be, in fact, as many as 50 different causes. While the two major types of dementia, Alzheimer's disease and multi-infarct dementia, are irreversible, perhaps 20 per cent of dementias are secondary to treatable causes, and are reversible. The most important of these is the pseudodementia of depression, which can be easily missed without a high degree of suspicion. Tips on the differential diagnosis of Alzheimer's disease, multi-infarct dementia, and pseudodementia are discussed, as are other causes of dementia secondary to various diseases or therapy.

Aged↗

Pseudodementia twelve years on.

This paper reports a longitudinal study of 19 patients diagnosed as having pseudodementia more than a decade earlier. In only one patient was the earlier diagnosis changed to definite dementia and, in this patient, there were strong indicators that such a diagnosis should have been made initially. In a second patient, dementia could not be excluded. The remaining patients did not show evidence of a dementing illness and the courses of the illnesses resembled the primary psychiatric disorders responsible for the pseudodementia. The results validate the clinical utility of the term "pseudodementia".

Adult↗

Regional cerebral blood flow abnormalities in depressed patients with cognitive impairment.

Depression with cognitive impairment, so called depressive pseudodementia, is commonly mistaken for a neurodegenerative dementia. Using positron emission tomography (PET) derived measures of regional cerebral blood flow (rCBF) a cohort of 33 patients with major depression was studied. Ten patients displayed significant and reversible cognitive impairment. The patterns of rCBF of these patients were compared with a cohort of equally depressed non-cognitively impaired depressed patients. In the depressed cognitively impaired patients a profile of rCBF abnormalities was identified consisting of decreases in the left anterior medial prefrontal cortex and increases in the cerebellar vermis. These changes were additional to those seen in depression alone and are distinct from those described in neurodegenerative dementia. The cognitive impairment seen in a proportion of depressed patients would seem to be associated with dysfunction of neural systems distinct from those implicated in depression alone or the neurodegenerative dementias.

Bipolar Disorder↗

Pseudodementia and physical findings masking significant psychopathology.

In a study of 53 medical-surgical patients who were in extended care and were consecutively referred for psychiatric evaluation, 7 (13%) of the patients had been considered to have unequivocal dementia, yet 3 of them (6% of the total or 43% of those considered demented) were found to have a false-dementing psychiatric disorder. Physical findings contributed to masking the psychopathology, which included psychotic depression with the Ganser symptom in 2 patients and hysterical pseudodementia with depression in 1 patient. Criteria that have been recommended to differentiate pseudodementia from dementia could lead to misdiagnosis in the type of case described, which suggests the need for a typology of depressive pseudodementia.

Adult↗

Overview: pseudodementia.

Despite the increased attention that the syndrome of pseudodementia is receiving, several important questions regarding diagnostic criteria and accuracy, etiology, and even the appropriateness of the term itself remain unanswered. The author reviews the literature on this topic, including published case reports. On the basis of the available data, it appears that there may be at least two categories of pseudodementia and that the cognitive impairment associated with depressive illness is more appropriately viewed as a depression-induced organic mental disorder. Directions for future research are suggested.

Adult↗

Neuropsychiatric evaluation in an outpatient setting.

In a retrospective case review of 336 outpatients who underwent neuropsychiatric evaluations, patients were sorted into five groups: 1) atypical psychiatric; 2) atypical neurological; 3) prior psychiatric/new-onset neurological; 4) prior neurological/new-onset psychiatric; 5) dementia versus pseudodementia. Cluster analysis of 19 presenting complaints differentiated among groups. Post-consultation changes in preconsultation diagnosis occurred frequently overall, with more new case finding for psychiatric than for neurological disorders. For example, mood disorder diagnoses increased from 7.7% to 16.1%. Overall, dementia was the most common postconsultation diagnosis (32.8%). The authors conclude that suspicion for dementia should be high in neuropsychiatric referrals and that mood disorders may be especially common in neuropsychiatric patients.

Adolescent↗

Long-term follow-up of depressive pseudodementia of the aged.

Forty-four elderly patients of both sexes (mean age 76.5 years) suffering from depressive pseudodementia were intensively treated for the depression. When that cleared up, cognitive function reverted to premorbid level. Patients were regularly interviewed and retested at six months intervals for four to 18 years (average 8). Some patients experienced, during the follow-up period, a recurrence of the depression for which they were again successfully treated. At the end of the observation period, 39 of the 44 patients (89%) had developed a dementia syndrome of the Alzheimer type.

Aged↗

Pseudodementia: facts and figures.

The historical and conceptual aspects of the pseudodementia state are briefly touched upon. A "collective sample", composed of 61 cases culled from the literature, is analysed and compared with the "Fulbourn sample" consisting of 22 cases reported for the first time. Two sub-types of pseudodementia emerge, one associated with depressive illness and the other with delirium. A follow-up of the Fulbourn sample (1-4 years after discharge) showed 14 patients to be alive and 8 to show no signs of dementia. No variable except the diagnosis "non-specific psychosis" correlated with death during the follow-up period.

Aged↗

Pseudodementia.

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Aged↗

Claimed simulation of insanity. A coping strategy in mania.

The coping strategy of claimed simulation of insanity observed at the onset of psychotic episodes in a manic patient is reported here. There is a need for systematic research on coping strategies in affective psychosis in order to develop techniques to help contain or prevent relapses.

Acting Out↗