Memory loss – is it dementia or pseudodementia?

Memory loss – is it dementia or pseudodementia?


By Associate Professor Dr AZNIDA FIRZAH ABDUL AZIZ

IF YOU are a spouse or a caregiver for an elderly person, you may be familiar with instances where your partner or dependent misplaces their personal belongings, repeatedly asks or mentions certain details during your conversations, movements were slowed down or has problems sleeping.

These symptoms are often passed off as “part of ageing”, and we tend to make excuses as these episodes may occasionally improve before we decide to get medical attention. The caregiver then faces the dilemma whether to inform the attending physician of these symptoms, and if at all, would there be anything that could be done.

A psychiatrist, Leslie Kiloh, in 1961, first described the above phenomenon as pseudodementia, after observing that patients who had memory problems and thinking skills became better when they were treated with antidepressants1. This led him to coin the term “pseudodementia”. The prefix “pseudo” means something that superficially appears to be (or behaves like) one thing, but actually is another. In this context, someone appears to have symptoms of dementia, but does not actually fit the criteria. Depression presents with memory-function deficits, especially those related to the task of remembering or recall.

The main reason this terminology was used was to differentiate between depression and dementia. This is especially important among the elderly because it not only prevents them from worsening depression, but it also prevents them from having to go through unnecessary evaluations to confirm dementia.

Azlina et al2 in their review on the issues and challenges of care for dementia in Malaysia concluded that awareness among the general public as well as healthcare providers needed to improve. Social stigmatisation related to being diagnosed with dementia3 is also an issue which may influence the need to seek help for loved ones who present with symptoms of dementia, or in any case symptoms which may resemble it, such as pseudodementia.

In terms of management, the difference between dementia and pseudodementia is that with appropriate treatment, pseudodementia will result in marked symptom improvement. Where as in the case of dementia, the aim of the treatment is to prevent further deterioration from the time the diagnosis is confirmed. Many caregivers who have not been adequately counselled on the benefits of medical treatment for dementia, often give up hope and feel that the expensive medicines were not effective as their loved ones do not appear to be “improving”.

Although there are many self-tests or questionnaires available online to gauge memory and cognitive function, these can help prompt the caregiver or the patient themselves to consult their family doctors. These self-tests can be used as a prompt for you to make the first move to discuss your concerns with your doctor. Some helpful hints to remember, as summarised by Kaszniak4:

  • Cognitive changes (i.e. memory, executive function and speech and language related) occur in the elderly.

  • Impairment in memory, executive function and speech and language accompanies depression and can be severe enough to cause confusion between dementia and depression.

  • Other diseases such as Alzheimer’s and Parkinson’s have symptoms that overlap with depression.

  • Dementia and depression can co-exist.

Some helpful tips to remember when consulting your doctor for memory-related problems:

  • An informant is necessary to help verify the patient’s history or claims; and

  • The informant should be the principal caregiver or the one who spends the most number of hours per day taking care of the patient.

Associate Professor Dr Aznida Firzah Abdul Aziz is a Family Medicine Consultant at the Department of Family Medicine, Faculty of Medicine, UKM Medical Centre, Hospital Canselor Tuunku Muhriz, Cheras.

References:

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

  2. Azlina WN, Hawthorne G, Al Mashoor SHA. Dementia in Malaysia: Issues and Challenges. Asean J Psychiatry. 12(1): Jan-June 2011. https://www.researchgate.net/publication/257368157_dementia_in_malaysia_issues_and_challenges

  3. La Fontaine J, Ahuja J, Bradbury NM, Philips S, Oyebode JR. Understanding Dementia Amongst People In Minority And Ethnic Cultural Groups. J Adv Nursing 2007. 60(6): 605-14

  4. Kaszniak AW. Neuropsychological consultation to geriatricians: Issues in the assessment of memory complaints. Clin Neuropsychol. 1987;1:35–46.

  5. http://pmr.penerangan.gov.my/index.php/sosial/9270-dimentia.html

Share this:

WP-Backgrounds by InoPlugs Web Design and Juwelier Schönmann