Pseudodementia: Is it Related to Dementia?

What is Pseudodementia?

Pseudodementia is a popular clinical concept (but not official diagnosis) that includes mental health conditions, that present like organic dementia but are contrastingly reversible. Depression is the most common condition that presents with a clinical picture of pseudodementia. This means depressive pseudodementia looks like dementia but isn’t.

In 1961, psychiatrist Leslie Kiloh observed that some of her patients with cognitive deficit symptoms like memory, attention, and personality disorders, got better when their mood improved. This means that the cognitive decline in these patients was actually due to mental health concerns and not a primary neuro-degenerative disorder of the brain like dementia, as was assumed.

Dementia by itself is known to be a more or less permanent decline in memory, intellect and personality which occurs when specific the cells of the brain (neurons) get irreversibly damaged. Since mental health conditions in Dr Kiloh’s patients were giving rise to a dementia like picture, the term “pseudodementia” (pseudo = false) came about to describe a “false” dementia which in fact was a boon to have because of its potential reversibility of cognitive impairment; unlike the “real” dementias.

How Common Is Pseudodementia?

It is not that uncommon to see patients with pseudodementia in the general population. Depression-associated pseudodementia has been frequently observed in people aged 65 years or older. Which means their memory cells are relatively intact and they can potentially function normally, but they (and their families) tend to believe that they have more serious cognitive impairment like dementia.

In fact, when such people see neurologists for assessment of cognitive decline, depression alone is the reason for forgetfulness in up to 4.5% of them. Also, when a young individual has such signs, it is even more likely to be pseudodementia. Many seasoned doctors can miss these reversible mood abnormalities because pseudodementia masquerades itself as real dementia so flawlessly.

Depression Associated Pseudodementia: Let’s Understand This

People who have moderate-to-severe depression frequently face difficulty in focusing their attention on matters at hand and get distracted by the mildest of interruptions. They also tend to think and execute tasks slowly compared to normal people. Planning becomes hard and implementing is decelerated by procrastination. These patients struggle with unclear thinking, concentration difficulties, decision-making challenges, notable forgetfulness, problems with reasoning, decreased motivation, worsened concentration and lessened brain agility. Effectively what you see is overall cognitive and memory dysfunction because of depression. This depression associated pseudodementia becomes impossible to differentiate from a real dementia simply because the symptoms could overlap so significantly.

Neurological Signs

  • Memory lapses
  • Misplacing items
  • Forgetting names
  • Speech difficulties
  • Difficulty Concentrating
  • Inability to focus
  • Inability to focus
  • Slowed mental speed
  • Poor information processing
  • Problem with planning
  • Task disorganization
  • Poor activity planning
  • Poor decision-making
  • Word-Finding Difficulty
  • Slowed movements

Slowed movements

  • Depressed mood
  • Emotional dysregulation
  • Fatigue or anergy
  • Over or under sleeping
  • Low and sad mood
  • Unable to enjoy (anhedonia)
  • Lack of appetite (anorexia)
  • Overeating (hyperphagia)
  • Suicidal thoughts or behavior
  • Blank facial expression
  • Giving up easily
  • Fluctuating mood
  • Fluctuating memory
  • Frustration over symptoms
  • Awareness of symptoms

Dementia Causing Depression: Is that Possible?

The diagnosis of dementia itself is a stressful emotional experience. The impact it has on everyday life, personal interactions, social activities, work commitments and finances can take a toll on one’s self-concept and self-worth. Advancing age already brings on conflict on account of loss of physical, financial and emotional power; this clubbed with a degenerative brain condition that one knows is seriously progressive, can damage the self-image significantly. Also, memory problems, distractibility and anhedonia (not enjoying anything) can result from specific nerve cell damage; hence one out of every two dementia patients, does show symptoms of depression.

Can Pseudodementia Progress to Dementia?

Depression compromises the human cognitive reserve. Neuroinflammation in the brain in depression stimulates the usually supportive brain cells called microglia to respond to false danger signals, thereby causing a cascade of seemingly protective mechanisms that eventually result in neuronal damage. Also, serotonin and dopamine chemical imbalance alongside excess stress hormone release destroy the hippocampus neurons which is the principal memory store in the brain. This cumulative brain injury caused by depression could unmask a latent dementia or initiate it insidiously.

How To Identify the Real Problem

The relationship is complicated – depression mimics dementia, depression could be seen in dementia and depression could cause dementia too. Differentiating primary depression from primary dementia is very important. However, this is also quite challenging. The distinction is complicated by the reality that symptoms appear similar; and that depressive pseudodementia is a predictor of subsequent dementia, and dementia itself can make one depressed.

While oftentimes both appear in the same person, sometimes it is possible to discern which emerged first. A notable and crucial difference between the two conditions is that in dementia, people forget, and they forget that they forgot. So, they could become nonchalant about their memory lapses and symptoms. In the pseudodementia of depression however, depressed individuals could seem frustrated about the fact that they cannot remember.

On cognitive tests, they try exceptionally hard and tend to be concerned about their performance. Memory lapse patterns could also differ wherein loss of immediate memories is more pronounced in true dementia whereas recent and distant memories both seem affected in depression associated dementia. Seeking professional consultation, detailed clinical and neurological evaluation and cognitive and emotional testing can be invaluable in discerning the diagnosis and the path of management.

Fact 1: Mimicry

Symptoms like memory loss, difficulty with executive functions, and speech problems can be exactly similar to those seen in dementia.

Fact 2: Reversibility

Cognitive deficits improve or disappear when the psychiatric disorder is treated, unlike the irreversible nature of true dementia.

Fact 3: Psychiatric Condition

Most commonly there is depression, but other conditions like mania, psychosis, can also lead to pseudodementia.

Fact 4: Quick Onset

Symptoms in dementia mostly develop gradually, unlike the often-sudden onset of symptoms seen in pseudodementia.

Fact5: Family History

Often, there’s family history of mood disorders in pseudodementia, while true dementia may have a family history of dementia.

Fact 6: The Mood

People with pseudodementia may show inconsistent mood while the mood in a true dementia might show stable but exaggerated mood.

Role of Cognitive Assessment

A seasoned mental health professional will be able to identify basal cognitive functioning by a simple bedside examination or clinical interview. But cognitive assessment gives a more detailed analysis by surveying multiple neuropsychological domains. This comprehensive investigation of cognition can diagnose major cognitive impairment (such as that seen in dementia and pseudodementia) as well as mild cognitive impairment.
The tests primarily measure memory, attention and concentration but the detailed multidimensional assessments involve language functions like naming, reading, writing, and repeating; executive tasks like planning, working memory, mental flexibility, list-making, and logical tasks like analyzing information, detecting patterns, and problem-solving skills too.

How Is Pseudodementia Managed?

Management of pseudodementia focuses on addressing the underlying psychiatric condition, (most commonly depression) which is responsible for the cognitive impairments that resemble dementia. Treatment usually involves a combination of psychotherapy, and medication (antidepressants) where warranted. Psychotherapy focuses on changing negative views of yourself, others, and the world at large.

Cognitive techniques like CBT (Cognitive Behavioral Therapy), REBT (Rational Emotive Behavior  Therapy) Therapy), ACT (Acceptance and Commitment Therapy) and Humanistic techniques like EFT (Emotion focused Therapy) and mindfulness, to name a few. All of these work on dysfunctional thoughts, emotions and behaviors that contribute to the development of depression and dementia-like symptoms. It’s very important to differentiate pseudodementia from true dementia, as the cognitive symptoms of pseudodementia can improve with treatment of the underlying depression, whereas dementia typically progresses.

Why You Should Not Ignore This

With medicine and technology continually improving, we are living longer lives. As a population that is increasing in age, the prevalence of cognitive impairment among us will inevitably rise. That is why fast, easy-to-use, and accurate cognitive tests that help diagnose, evaluate, and manage many aspects of cognitive impairment are invaluable in identifying and managing cognitive disturbances.

Dr Shefali Batra believes in a thorough and detailed history with medical psychiatric, psychological and neurological examination alongside neuroscience backed cognitive assessments. We collaborate with Ivory (link to liveivory.com) that offers a 360° cognitive profiling alongside risk factor analysis. Don’t ignore your brain’s functioning. You’ve got only one and it’s priceless.

References

  • Brodaty, H., & Connors, M. H. (2020). Pseudodementia, pseudo-pseudodementia, and pseudodepression. Alzheimer’s & dementia (Amsterdam, Netherlands), 12(1), e12027.
  • Gonzalez Kelso I, Tadi P. Cognitive Assessment. [Updated 2022 Nov 7]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan
  • Mouta, S., Fonseca Vaz, I., Pires, M., Ramos, S., & Figueiredo, D. (2023). What do we know about pseudodementia? General psychiatry, 36(4), e100939.

Related topics

Latest Posts

Since I travel so much worldwide, I have been taking online sessions for lifestyle and stress related issues with Dr Shefali. It’s so convenient, flexible, and accessible!
CS, Paris, France
With her mindfulness approach, Dr Shefali ignited my drive to become stronger, self-aware, and a better person. She’s been kind, patient and understanding. I’m extremely grateful.
HH, Indore, India
Dr Shefali helped me delve into the root of my troubles to resolve them. And I achieved all this without any medicines, that's the most amazing part. I'm really thankful!
RG, Mumbai, India
I was hesitant to see a Psychiatrist but Dr Shefali made me realize that people shouldn’t go to a doctor just to solve problems; we need preemptive help to prevent them. Thanks!
SG, Mumbai, India
The ease with which I could open up, indulge and confess in front of Dr Shefali deserves applause. It's wonderful how she created this space to connect. And helped me survive and thrive.
SC, Rourkela, India
On my second visit to Dr Shefali, I got relief from an illness that had been haunting me for 35 years.The past 18 years of my life have been the most meaningful Thanks!
PS, Mumbai, India
I met Dr Shefali for chronic social anxiety (on-going for 14 years). I had almost given up on getting better. And now I am LIVING my life. Thank you, Doc for bringing me back to life!
SM, Mumbai, India

Get In Touch

Whatsapp Instagram Quora Spotify Linkedin Youtube Twitter Facebook-f