Skip to main content
SpringerLink
Log in

Depression, Dementia, and Pseudodementia

  • Chapter
  • First Online:
Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches

Abstract

Depression and dementia represent frequent clinical presentations in the elderly population. Both diseases are interlinked. Indeed, depression in the elderly may reflect an increased risk for the later development of dementia. Worldwide, about 47 million people are affected by dementia, which represents about 10% of the general population over 65 years of age. On the other hand, among elderly people, the prevalence of depressive symptoms and major depressive disorder (MDD) is 15% and 1–3%, respectively. Female gender, alcohol and substance or drug abuse, family history, and medical conditions are factors associated with depression in the elderly.

In the present chapter we specifically focus on discrimination between elderly MDD and major neurocognitive disorder. Concerning this point, two steps have to be performed: (1) observation of clinical response to antidepressants’ treatment, taking into consideration a possible longer latency of antidepressants’ efficacy in elderly/lower response to antidepressants in older age, and (2) cross-clinical assessments with neuropsychological evaluation, imaging, and laboratory tests.

Considering the background of the present literature, we pointed out the case of a woman, 72 years old, with a long history of MDD and a recent diagnosis of mild cognitive impairment (MCI). She was referred to our outpatient clinic for a relapsing depressive episode. In the present case presentation, we investigated the differential diagnostic process, observing clinical course, using neuropsychological evaluation, blood and urine laboratory exams, computed tomography, magnetic resonance imaging, positron emission tomography, cerebrospinal fluid analysis, and electroencephalogram.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Steffens DC, Otey E, Alexopoulos GS, Butters MA, Cuthbert B, Ganguli M, et al. Perspectives on depression, mild cognitive impairment, and cognitive decline. Arch Gen Psychiatry. 2006;63(2):130. https://doi.org/10.1001/archpsyc.63.2.130.

    Article  PubMed  Google Scholar 

  2. Heser K, Tebarth F, Wiese B, Eisele M, Bickel H, Köhler M, et al. Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe). Psychol Med. 2013;43(8):1597–610. https://doi.org/10.1017/S0033291712002449.

    Article  CAS  PubMed  Google Scholar 

  3. Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and meta-regression analysis. Arch Gen Psychiatry. 2006;63(5):530–8. https://doi.org/10.1001/archpsyc.63.5.530.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Diniz BS, Butters MA, Albert SM, Dew MA, Reynolds CF. Late-life depression and risk of vascular dementia and Alzheimer’s disease: systematic review and meta-analysis of community-based cohort studies. Br J Psychiatry. 2013;202(5):329–35. https://doi.org/10.1192/bjp.bp.112.118307.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mintzer J, Targum SD. Psychosis in elderly patients: classification and pharmacotherapy. J Geriatr Psychiatry Neurol. 2003;16(4):199–206. https://doi.org/10.1177/0891988703258658.

    Article  PubMed  Google Scholar 

  6. WHO-Dementia. World Health Organization endorses global action plan on rising incidence of dementia. Nurs Older People. 2017;29(6):7–7. https://doi.org/10.7748/nop.29.6.7.s6.

    Article  Google Scholar 

  7. Espinoza RT. Improving the recognition and management of dementia in long-term care: obstacles and opportunities. J Am Med Dir Assoc. 2006;7(2):128–30. https://doi.org/10.1016/j.jamda.2005.10.002.

    Article  PubMed  Google Scholar 

  8. Fillit HM, Doody RS, Binaso K, Crooks GM, Ferris SH, Farlow MR, et al. Recommendations for best practices in the treatment of Alzheimer’s disease in managed care. Am J Geriatr Pharmacother. 2006;4(Suppl A):S9–S28. https://doi.org/10.1016/j.amjopharm.2006.10.001.

    Article  PubMed  Google Scholar 

  9. Pazzaglia P. Clinica Neurologica. 7 edizione. Capitolo “Demenze”; 2012.

    Google Scholar 

  10. Roberson ED, Hesse JH, Rose KD, Slama H, Johnson JK, Yaffe K, et al. Frontotemporal dementia progresses to death faster than Alzheimer disease. Neurology. 2005;65(5):719–25. https://doi.org/10.1212/01.wnl.0000173837.82820.9f.

    Article  CAS  PubMed  Google Scholar 

  11. Rosso SM, Donker Kaat L, Baks T, Joosse M, de Koning I, Pijnenburg Y, et al. Frontotemporal dementia in The Netherlands: patient characteristics and prevalence estimates from a population-based study. Brain J Neurol. 2003;126(Pt 9):2016–22. https://doi.org/10.1093/brain/awg204.

    Article  Google Scholar 

  12. Brown GM, McIntyre RS, Rosenblat J, Hardeland R. Depressive disorders: processes leading to neurogeneration and potential novel treatments. Prog Neuro-Psychopharmacol Biol Psychiatry. 2017;80(Pt C):189–204. https://doi.org/10.1016/j.pnpbp.2017.04.023.

    Article  CAS  Google Scholar 

  13. Mulsant BH, Ganguli M. Epidemiology and diagnosis of depression in late life. J Clin Psychiatry. 1999;60(Suppl 20):9–15. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10513852

  14. CADTH-Depression. Diagnosing, screening, and monitoring depression in the elderly: a review of guidelines – PubMed – NCBI. Canadian Agency for Drugs and Technologies in Health; 2015. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26468558.

  15. Copeland JRM, Beekman ATF, Braam AW, Dewey ME, Delespaul P, Fuhrer R, … Wilson KCM. Depression among older people in Europe: the EURODEP studies. World Psychiatry. 2004;3(1):45–9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16633454.

  16. Fereshtehnejad S-M, Johannsen P, Waldemar G, Eriksdotter M. Dementia diagnosis, treatment, and care in specialist clinics in two Scandinavian countries: a data comparison between the Swedish Dementia Registry (SveDem) and the Danish Dementia Registry. J Alzheimers Dis. 2015;48(1):229–39. https://doi.org/10.3233/JAD-150144.

    Article  PubMed  Google Scholar 

  17. Miller AM, Begley E, Coen R, Doyle M, Dunne J, Hutchinson S, … Lawlor BA. Clinical consensus guidelines on the application of cerebrospinal fluid biomarkers for Alzheimer’s disease diagnosis: recommendations of the Irish network for biomarkers in neurodegeneration. Ir Med J. 2016;109(10):483. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/28644588.

  18. Hofmann W. Guideline-based diagnosis of dementia etiology. Zeitschrift Fur Gerontologie Und Geriatrie. 2012;45(8):761–71–3. https://doi.org/10.1007/s00391-012-0399-y

    Article  CAS  PubMed  Google Scholar 

  19. APA American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-V; 2013.

    Google Scholar 

  20. APA American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV; 1994.

    Google Scholar 

  21. Gold DA. An examination of instrumental activities of daily living assessment in older adults and mild cognitive impairment. J Clin Exp Neuropsychol. 2012;34(1):11–34. https://doi.org/10.1080/13803395.2011.614598.

    Article  PubMed  Google Scholar 

  22. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969;9(3):179–86. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/5349366.

    Article  CAS  PubMed  Google Scholar 

  23. Ozer S, Young J, Champ C, Burke M. A systematic review of the diagnostic test accuracy of brief cognitive tests to detect amnestic mild cognitive impairment. Int J Geriatr Psychiatry. 2016;31(11):1139–50. https://doi.org/10.1002/gps.4444.

    Article  PubMed  Google Scholar 

  24. Tsoi KKF, Chan JYC, Hirai HW, Wong SYS, Kwok TCY. Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Intern Med. 2015;175(9):1450–8. https://doi.org/10.1001/jamainternmed.2015.2152.

    Article  PubMed  Google Scholar 

  25. Carlesimo GA, Caltagirone C, Gainotti G. The mental deterioration battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. The group for the standardization of the mental deterioration battery. Eur Neurol. 1996;36(6):378–84. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8954307.

    Article  CAS  PubMed  Google Scholar 

  26. Barthel H, Schroeter ML, Hoffmann K-T, Sabri O. PET/MR in dementia and other neurodegenerative diseases. Semin Nucl Med. 2015;45(3):224–33. https://doi.org/10.1053/j.semnuclmed.2014.12.003.

    Article  PubMed  Google Scholar 

  27. Lista S, Toschi N, Baldacci F, Zetterberg H, Blennow K, Kilimann I, et al. Cerebrospinal fluid neurogranin as a biomarker of neurodegenerative diseases: a cross-sectional study. J Alzheimers Dis. 2017;59(4):1327–34. https://doi.org/10.3233/JAD-170368.

    Article  CAS  PubMed  Google Scholar 

  28. Società Italiana di Neuroscienze. Expert Panel Alzheimer. Malattia di Alzheimer. Documento di consenso, DSM-V, MMSE, RMN, Liquor, es. ematici per escludere infezioni disdratazione, squilibri elettrolitici, disfunzioni tiroidee; 1999.

    Google Scholar 

  29. Neto E, Biessmann F, Aurlien H, Nordby H, Eichele T. Regularized linear discriminant analysis of EEG features in dementia patients. Front Aging Neurosci. 2016;8:273. https://doi.org/10.3389/fnagi.2016.00273.

    Article  PubMed  PubMed Central  Google Scholar 

  30. De Carlo V, Calati R, Serretti A (2016). Socio-demographic and clinical predictors of non-response/non-remission in treatment resistant depressed patients: a systematic review. Psychiatry Research. Elsevier Ireland Ltd.

    Google Scholar 

  31. Bennett S, Thomas AJ. Depression and dementia: cause, consequence or coincidence? Maturitas. 2014;79(2):184–90. https://doi.org/10.1016/j.maturitas.2014.05.009.

    Article  PubMed  Google Scholar 

  32. Butters MA, Young JB, Lopez O, Aizenstein HJ, Mulsant BH, Reynolds CF, … Becker JT. Pathways linking late-life depression to persistent cognitive impairment and dementia. Dialogues Clin Neurosci. 2008;10(3):345–57. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18979948.

  33. Sheline YI, Barch DM, Garcia K, Gersing K, Pieper C, Welsh-Bohmer K, et al. Cognitive function in late life depression: relationships to depression severity, cerebrovascular risk factors and processing speed. Biol Psychiatry. 2006;60(1):58–65. https://doi.org/10.1016/j.biopsych.2005.09.019.

    Article  PubMed  Google Scholar 

  34. Panza F, Frisardi V, Capurso C, D’Introno A, Colacicco AM, Imbimbo BP, et al. Late-life depression, mild cognitive impairment, and dementia: possible continuum? Am J Geriatr Psychiatry. 2010;18(2):98–116. https://doi.org/10.1097/JGP.0b013e3181b0fa13.

    Article  PubMed  Google Scholar 

  35. Huang C-Q, Wang Z-R, Li Y-H, Xie Y-Z, Liu Q-X. Cognitive function and risk for depression in old age: a meta-analysis of published literature. Int Psychogeriatr. 2011;23(4):516–25. https://doi.org/10.1017/S1041610210000049.

    Article  PubMed  Google Scholar 

  36. Djernes JK. Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr Scand. 2006;113(5):372–87. https://doi.org/10.1111/j.1600-0447.2006.00770.x.

    Article  CAS  PubMed  Google Scholar 

  37. Enache D, Winblad B, Aarsland D. Depression in dementia: epidemiology, mechanisms, and treatment. Curr Opin Psychiatry. 2011;24(6):461–72. https://doi.org/10.1097/YCO.0b013e32834bb9d4.

    Article  PubMed  Google Scholar 

  38. Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, et al. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005;366(9503):2112–7. https://doi.org/10.1016/S0140-6736(05)67889-0.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. “Vascular depression” hypothesis. Arch Gen Psychiatry. 1997;54(10):915–22. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9337771

    Article  CAS  PubMed  Google Scholar 

  40. Flicker L. Vascular factors in geriatric psychiatry: time to take a serious look. Curr Opin Psychiatry. 2008;21(6):551–4. https://doi.org/10.1097/YCO.0b013e32830ef736.

    Article  PubMed  Google Scholar 

  41. Teper E, O’Brien JT. Vascular factors and depression. Int J Geriatr Psychiatry. 2008;23(10):993–1000. https://doi.org/10.1002/gps.2020.

    Article  PubMed  Google Scholar 

  42. de Groot JC, de Leeuw FE, Oudkerk M, Hofman A, Jolles J, Breteler MM. Cerebral white matter lesions and depressive symptoms in elderly adults. Arch Gen Psychiatry. 2000;57(11):1071–6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11074873.

    Article  CAS  PubMed  Google Scholar 

  43. Kiloh LG. Pseudo-dementia. Acta Psychiatr Scand. 1961;37:336–51.

    Article  CAS  PubMed  Google Scholar 

  44. Coutinho G, Drummond C, Teldeschi A, Mattos P. Awareness of memory deficits is useful to distinguish between depression and mild cognitive impairment in the elderly. Rev Bras Psiquiatr. 2016;38(3):231-234. doi: https://doi.org/10.1590/1516-4446-2015-1772. Epub 2016 May 17

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kang H, Zhao F, You L, Giorgetta C, Venkatesh D, Sarkhel S, Prakash R. Pseudo-dementia: A neuropsychological review. Ann Indian Acad Neurol. 2014 Apr-Jun; 17(2):147–54. PMID: 25024563.

    Google Scholar 

  46. Lara E, Koyanagi A, Domènech-Abella J, Miret M, Ayuso-Mateos JL, Haro JM. The impact of depression on the development of mild cognitive impairment over 3 years of follow-up: a population-based study. Dement Geriatr Cogn Disord. 2017;43(3–4):155–69. https://doi.org/10.1159/000455227.

    Article  PubMed  Google Scholar 

  47. Petersen RC, Roberts RO, Knopman DS, Boeve BF, Geda YE, Ivnik RJ, et al. Mild Cognitive Impairment. Arch Neurol. 2009;66(12):1447–55. https://doi.org/10.1001/archneurol.2009.266.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Apostolova LG, Cummings JL. Neuropsychiatric manifestations in mild cognitive impairment: a systematic review of the literature. Dement Geriatr Cogn Disord. 2007;25(2):115–26. https://doi.org/10.1159/000112509.

    Article  PubMed  Google Scholar 

  49. Brodaty H, Heffernan M, Kochan NA, Draper B, Trollor JN, Reppermund S, et al. Mild cognitive impairment in a community sample: The Sydney Memory and Ageing Study. Alzheimers Dement. 2013;9(3):310–317.e1. https://doi.org/10.1016/j.jalz.2011.11.010.

    Article  PubMed  Google Scholar 

  50. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256(3):183–94. https://doi.org/10.1111/j.1365-2796.2004.01388.x.

    Article  CAS  PubMed  Google Scholar 

  51. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund L-O, et al. Mild cognitive impairment–beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;256(3):240–6. https://doi.org/10.1111/j.1365-2796.2004.01380.x.

    Article  CAS  PubMed  Google Scholar 

  52. Petersen RC, Aisen PS, Beckett LA, Donohue MC, Gamst AC, Harvey DJ, et al. Alzheimer’s Disease Neuroimaging Initiative (ADNI): clinical characterization. Neurology. 2010;74(3):201–9. https://doi.org/10.1212/WNL.0b013e3181cb3e25.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Xu W, Tan L, Wang H-F, Jiang T, Tan M-S, Tan L, et al. Meta-analysis of modifiable risk factors for Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2015;86(12):1299–306. https://doi.org/10.1136/jnnp-2015-310548.

    Article  PubMed  Google Scholar 

  54. Byers AL, Yaffe K. Depression and risk of developing dementia. Nat Rev Neurol. 2011;7(6):323–31. https://doi.org/10.1038/nrneurol.2011.60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Kaszniak AW, Fox J, Gandell DL, Garron DC, Huckman MS, Ramsey RG. Predictors of mortality in presenile and senile dementia. Ann Neurol. 1978;3(3):246–52.

    Article  CAS  PubMed  Google Scholar 

  56. Richard E, Reitz C, Honig LH, Schupf N, Tang MX, Manly JJ, et al. Late-Life Depression, Mild Cognitive Impairment, and Dementia. JAMA Neurol. 2013;70(3):383. https://doi.org/10.1001/jamaneurol.2013.603.

    Article  Google Scholar 

  57. Kessing LV, Søndergård L, Forman JL, Andersen PK. Antidepressants and dementia. J Affect Disord. 2009;117(1–2):24–9. https://doi.org/10.1016/j.jad.2008.11.020.

    Article  CAS  PubMed  Google Scholar 

  58. Steiner JP, Bachani M, Wolfson-Stofko B, Lee M-H, Wang T, Wang T, et al. Interaction of paroxetine with mitochondrial proteins mediates neuroprotection. Neurotherapeutics. 2015;12(1):200–16. https://doi.org/10.1007/s13311-014-0315-9.

    Article  CAS  PubMed  Google Scholar 

  59. Chang K-A, Kim JA, Kim S, Joo Y, Shin KY, Kim S, et al. Therapeutic potentials of neural stem cells treated with fluoxetine in Alzheimer’s disease. Neurochem Int. 2012;61(6):885–91. https://doi.org/10.1016/j.neuint.2012.03.017.

    Article  CAS  PubMed  Google Scholar 

  60. Tifratene K, Robert P, Metelkina A, Pradier C, Dartigues JF. Progression of mild cognitive impairment to dementia due to AD in clinical settings. Neurology. 2015;85(4):331–8. https://doi.org/10.1212/WNL.0000000000001788.

    Article  PubMed  Google Scholar 

  61. Halahakoon DC, Roiser JP. Cognitive impairment in depression and its (non-)response to antidepressant treatment. Evid Based Ment Health. 2016;19(4):e23–e23. https://doi.org/10.1136/eb-2016-102438.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Sara Pozzoli, Vera De Carlo & Domenico Madonna

Authors
  1. Sara Pozzoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vera De Carlo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Domenico Madonna
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Neuroscience and Mental Health, IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Alfredo Carlo Altamura

  2. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy, IRCCS “E. Medea” Scientific Institute, Bosisio Parini (Lc), Italy

    Paolo Brambilla

Self-Assessment Questionnaire

Self-Assessment Questionnaire

  1. 1.

    What is the most common type of dementia that shows an early onset, compared to the others?

    1. (A)

      Alzheimer’s disease

    2. (B)

      Dementia with Lewy body

    3. (C)

      Frontotemporal dementia

    4. (D)

      Parkinson’s disease

  2. 2.

    Who has been coined for the first ever term “pseudodementia”?

    1. (A)

      Kraepelin, 1880

    2. (B)

      Kohl, 1961

    3. (C)

      Babinski, 1900

    4. (D)

      Perusini, 1930

  3. 3.

    What is the main difference between dementia and pseudodementia?

    1. (A)

      The reversibility of pseudodementia after treatment.

    2. (B)

      The reversibility of memory deficits in dementia patients.

    3. (C)

      Mood disorders are more often associated with dementia than pseudodementia.

    4. (D)

      Antidepressants don’t have any effect in pseudodementia patients, compared to dementia.

  4. 4.

    What, among these, is the cause that most frequently can simulate a delirium in the geriatric population?

    1. (A)

      Celiac disease

    2. (B)

      Thyroid dysfunction

    3. (C)

      Iron deficiency

    4. (D)

      Cardiac alterations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pozzoli, S., De Carlo, V., Madonna, D. (2019). Depression, Dementia, and Pseudodementia. In: Altamura, A., Brambilla, P. (eds) Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches. Springer, Cham. https://doi.org/10.1007/978-3-319-91557-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-91557-9_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91556-2

  • Online ISBN: 978-3-319-91557-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation