Pseudodementia in Seniors


by Bob Kohut

When most of us come in contact with an elderly senior who seems to be losing their memories and speaking and moving about more slowly than they used to, we often automatically assume that dementia is setting in.  Since most forms of dementia are considered untreatable, we do the best we can to deal with the situation as it is without seeking medical help.

Did you know many of the symptoms of depression are identical to those of dementia?  Did you know that some experts estimate that between 15 and 20% of seniors suffer from some form of depression?

Back in 1961 a psychiatrist named Leslie Kiloh discovered that some seniors with dementia like symptoms actually improved when treated for depression.  He introduced the term pseudo dementia, or false dementia.  Apparently this phenomenon was suspected for many years but even today some researchers and psychiatrists feel the term should not be used as a classification system for diagnosis and treatment.

Let the scientists argue amongst themselves, but for those responsible for seeing to the well being of any aging senior, the implications of pseudodementia are profound.

Today many seniors who are fortunate enough to get a proper diagnosis of pseudodementia instead of dementia are responding to antidepressant treatments for clinical depression.  In many cases the dementia like symptoms are completely reversed.

Seniors suffering from real pseudodementia should undergo memory testing and other medical diagnosis to see if they are actually victims of depression instead of real dementia.

Can caregivers tell the difference between true dementia and clinical depression?  There are some potentially tell-tale clues that might be present, beyond the obvious ones of memory loss, confusion, and slurred speech and slower movements.  Here are a few things to look for.

  • Frequent crying for no apparent reason and expressed feelings of hopelessness and sadness can be signs of depression.

  • Decreasing interest in daily activities and activities the senior used to enjoy can be signs of depression.

  • Changes in eating and sleeping habits and increased irritability can be symptoms of depression.

  • Physical manifestations of inner sadness, such as blank stares and slouching in chairs, can be symptoms of depression.

  • Physical aches and pains that don’t respond to treatment might be signs of depression.

  • Lack of attention to personal hygiene and dress could be symptoms of depression.

While the presence of these signs may raise the suspicions of an alert caregiver, the only way to know for sure what is going on is to get that senior to the right doctors for proper diagnosis.

Unfortunately that is often easier said than done.  Most seniors alive today grew up during a time when depression was seen as some form of personal failing.  Back then, depressed people were advised to tough it out and solve their own problems.  Some seniors go so far as to suspect the depression engulfing them is a form of punishment for the sins committed in the days of their youth.

To counteract this, caregivers need to start the diagnosis with a non-threatening family physician.  While some experts advise lengthy conversations to convince your afflicted senior loved ones that depression is an illness not a moral deficiency, there is something to be said for simply not mentioning the word “depression.”

However you decide to handle it, remember that depression in seniors may be far more prevalent than previously imagined and is treatable.


3 Responses

  1. Thank you for this very important information. Aside from depression there are other factors that can mimic dementia including drug interactions. You are so right that it is very important not to just assume that because someone is old and seems to be forgetful that they have Alzheimer's or dementia. I have been glad to discover that there are even positive changes that can happen in the psychology of the very old that can be mistaken for dementia. People who have developed psychologically into a stage that is called "gerotranscendence" may appear to be withdrawn and confused when in fact they are experiencing higher levels of consciousness and ecstatic spiritual states. I write about this at Carol Inside Aging Parent Care
  2. Hard to tell if depression when your 76 yr old father ends up losing his ability to move his limbs, his vision, ability to eat, walk, transfer, or bathroom on his own. If that happened to me in a 6 month period I'm pretty sure some level of depression would be there.
  3. Is it right to follow and believe a Boss who's work is not satisfactory to his seniors?