Understanding Pseudodementia

Pseudodementia is a loss of cognitive abilities that appears alongside other psychological or psychiatric conditions. Most commonly associated with depression, pseudodementia mimics other forms of dementia without sharing the same physical changes in brain structure and function.

Some experts believe pseudodementia can be a sign that other types of dementia will develop later, but pseudodementia has been reversed with effective treatment of the underlying psychiatric condition.

While pseudodementia and dementia may sometimes look similar, they are, in fact, different conditions. There are several ways the conditions are different.

Brain scan results

The main difference between pseudodementia and dementia is that observable changes in the structure of the brain do not cause pseudodementia. In people with dementia, there is a significant loss in brain volume — usually a 10% to 50% loss in the hippocampus.

Studies that compared measurements of the hippocampus in people with Alzheimer’s disease (AD) and those who have depressive pseudodementia (DPD) found reductions in both the left and right hippocampus in people with AD.

While people with DPD only showed slight decreases in the size of the left hippocampus, people with AD had greater decreases.

Types of memory loss present

Outside of the structural changes, dementia usually begins with short-term memory losses, while pseudodementia may affect both short-term and long-term memory.

Behavioral changes

There are some behavioral differences between dementia and pseudodementia. People with most forms of dementia often try to conceal their lapses in memory and cognitive function, but people with pseudodementia tend to highlight or call attention to their symptoms.

Response to treatment

Pseudodementia can be reversible if the psychiatric condition that is triggering it is treated effectively. Treatment for dementia is primarily focused on managing symptoms.

The majority of the noticeable symptoms of dementia and pseudodementia are similar. These symptoms can include problems with:

• memory
• judgment
• decision-making
• cognitive function

There are no signs or symptoms of pseudodementia that show up on imaging studies or laboratory tests.

Pseudodementia usually masks an underlying psychiatric condition that either has not been diagnosed or effectively treated. Depression and major depressive disorder are the psychiatric conditions most often associated with pseudodementia.

Other less common disorders that may be associated with pseudodementia include:

• psychosis
• mania
• conversion disorder

A 2018 review of studies that included data for 284 people diagnosed with pseudodementia, found that 33% had developed irreversible dementia at follow-up, while 53% no longer met the criteria for dementia diagnosis.

Pseudodementia is primarily diagnosed through observation of behavior or memory changes and neurocognitive testing.

Imaging studies and other lab tests may be performed to rule out other forms of neurodegenerative dementia, but an absence of changes in the size, structure, or function of the brain is not seen in people with pseudodementia.

Another way to tell the difference between neurogenerative forms of dementia and pseudodementia is to treat associated symptoms like depression. Treatment with antidepressants and other psychiatric medications that helped to resolve any coexisting conditions have reversed the cognitive changes seen in pseudodementia for the majority of people who develop this condition.

In some cases, however, pseudodementia is believed to be closer to a form of pre-dementia. Whether pseudodementia is an early stage of neurodegenerative forms of the disease or whether having pseudodementia increases the risk of developing other forms of dementia later remains to be seen.

Depression has been observed as a risk factor for neurodegenerative forms of dementia in some studies, but other reports have been inconsistent in estimating how many cases of pseudodementia later progress to dementia. Across multiple studies, between 10% and 90% of people who were at one time diagnosed with pseudodementia were later found to have irreversible or neurodegenerative forms of dementia.

A history of depression or other psychiatric disorders is the primary risk factor associated with pseudodementia, but the problem may also be more common in populations with high rates of depressive disorders like:

• people over age 65
• people assigned female at birth
• people with alcohol and substance use disorders

In most cases, pseudodementia appears to be a reversible condition with the proper treatment. Treatment usually involves things targeting underlying psychiatric disorders like depression. Some researchers argue that some degree of cognitive changes will continue, even in people whose pseudodementia was apparently reversed.

There is also evidence that pseudodementia may be a form of pre-dementia or may increase a person’s chances of developing neurocognitive dementia later in life.

Can you develop pseudodementia when you are younger than age 65 years?

Anyone can develop pseudodementia, but most of the literature on the condition focuses on adults 65 years and older. The strongest risk factor for developing pseudodementia is a history of or current depression rather than age.

Is there a specific test to diagnose pseudodementia?

There’s no specific test to diagnose pseudodementia. If pseudodementia is suspected, though, you may undergo a number of tests aimed at ruling out other neurodegenerative conditions.

Can pseudodementia be cured?

There’s no medication that directly treats or cures pseudodementia. Instead, other psychiatric issues like depression are often treated, and a resolution of cognitive problems follows.

Pseudodementia is a usually reversible condition that occurs when the symptoms of a psychiatric condition like depression resemble the decline in cognitive abilities seen in dementia.

In most cases, treatment of underlying issues like depression can help to reverse symptoms of pseudodementia.