An Overview of Pseudodementia

Symptoms, Diagnosis, Treatment

"Pseudodementia" is a term—not an official diagnosis—that is sometimes used to describe symptoms that resemble dementia but are actually due to other conditions, most commonly depression. Thus, depressive pseudodementia has symptoms of dementia but, unlike true dementia, these symptoms may be reversible with treatment for depression.

Man staring out the window
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In other cases, pseudodementia has been identified as a possibility in schizophrenia, other psychoses, dissociative disorder, conversion disorder, and mania.

This article describes the history of this term and lists the characteristics and symptoms of pseudodementia. You'll learn the difference between dementia and pseudodementia and the role that depression plays. You'll also find out how healthcare providers screen for, diagnose, and treat this condition.

History

Though the term "pseudodementia" was being used prior, it wasn’t until psychiatrist Leslie Kiloh published the paper “Pseudo-dementia” in 1961 that others were given the impetus to try reversing cognitive impairments that may have been due to other psychiatric disorders, such as depression.

It's hard to classify exactly what pseudodementia is. Plus, its name is misleading. That's why some professionals advocate stopping using this term altogether. Others argue that pseudodementia is still a useful term because it can help identify patients who may have a treatable condition.

What Are the Symptoms of Pseudodementia?

Pseudodementia can be thought of as cognitive impairment that looks like dementia but is actually due to depression. Common symptoms of pseudodementia look a lot like dementia symptoms and include memory loss and impaired executive functioning. Executive functioning impacts the ability to make decisions, as well as plan and organize ideas.

Pseudodementia vs. Dementia

While pseudodementia is not included in the "Diagnostic and Statistical Manual" 5th Edition, there may still be value in trying to differentiate it from dementia. One study noted that people who were experiencing the cognitive deficits of pseudodementia had the following characteristics:

  • They displayed equal memory loss for recent and past events where typically, short-term memory loss would be the more common early-stage dementia symptom.
  • Their memory loss was described as "patchy" and specific.
  • They frequently answered that they “didn’t know” when asked questions.
  • Their cognitive ability varied significantly when given different neuropsychological tasks that were of about the same level of difficulty.

Though others have made this list more clinically specific, the above has been a good benchmark to start.

Experiencing Both Dementia and Depression

Older adults are at an increased risk of experiencing dementia and depression. To complicate things, they can also experience a combination of dementia and depression. This challenge may be one reason why there have been reports of high rates of both false-positive and false-negative errors in the diagnosis of dementia.

So, how do you tell the difference between depression and dementia? One important factor is that people with depression might complain about their memory, but they often do reasonably well on mental status exams and other tests that evaluate cognitive function.

On the other hand, those with dementia often deny any memory problems but don't do as well on cognitive tests. Also, a depressed person is less likely to show severe mood swings, whereas someone with dementia shows a wider range of emotions and sometimes makes inappropriate emotional responses (e.g., laughing while others are sad).

Screening and Diagnosis

There are many different opinions out there about the idea of pseudodementia. Some clinicians use this term regularly and describe seeing multiple patients who were incorrectly diagnosed with dementia and whose cognitive functioning later improved with treatment for their depression.

However, other physicians question this idea of pseudodementia and refer to cases where memory loss that might have been initially blamed on depression progressed to true dementia. Their perspective is that cognitive impairment, along with the signs of depression, were merely early signs of the individual's dementia.

The Geriatric Depression Scale (GDS) is a screening instrument used to detect depression among older adults. The GDS should be one of several methods used in an evaluation. Older adults might have depression that looks like Alzheimer's or they might have both depression and Alzheimer's or other dementia.

If depression is detected, it can be treated alongside other disorders, such as Alzheimer's disease. The Cornell Scale for Depression in Dementia is another helpful screening test to use since it helps identify whether both depression and dementia are present.

Treatment

If the cause of the memory loss is untreated depression, treatment of pseudodementia, therefore, would essentially be the same as treatment for depression, including antidepressant medication.

Summary

While not an official diagnosis, pseudodementia appears to have the same loss of memory and executive functioning seen in dementia, but its true cause is depression. Pseudodementia has become an important factor to consider in the care and treatment of older adults.

See a healthcare provider when symptoms of dementia or depression become apparent. The timely diagnosis of depression, dementia, and depression in dementia, can help improve quality of life and life functioning for older adults.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kang H, Zhao F, You L, Giorgetta C, D V, Sarkhel S, Prakash R. Pseudo-dementia: a neuropsychological review. Ann Indian Acad Neurol. 2014;17(2):147-54. doi:10.4103/0972-2327.132613

  2. Mouta S, Fonseca Vaz I, Pires M, Ramos S, Figueiredo D. What do we know about pseudodementia? Gen Psychiatry. 2023;36e:100939. doi:10.1136/gpsych-2022-100939

  3. Sahin S, Okluoglu Önal T, Cinar N, Bozdemir M, Çubuk R, Karsidag S. Distinguishing depressive pseudodementia from Alzheimer disease: A comparative study of hippocampal volumetry and cognitive testsDement Geriatr Cogn Dis Extra. 2017;7(2):230–239. Published 2017 Jul 4. doi:10.1159/000477759

Additional Reading

By Carrie Hill, PhD
 Carrie L. Hill, PhD has over 10 years of experience working for agencies in the health, human service, and senior sectors, including The Alzheimer's Association in St. George, Utah.