What is Pseudodementia? [Diagnosis, Treatment]

What is Pseudodementia? [Diagnosis, Treatment]

What is pseudodementia? Pseudodementia is a mental illness of cognitive decline that has a number of the same symptoms that are found in people with dementia and does resemble dementia.

In this article we delve deeply into the question, what is pseudodementia, looking at the history of the condition, diagnosis and treatment.

Usually, pseudodementia has other underlying causes – with depression being a very common one. The patient’s symptoms must be carefully assessed so that they get the correct diagnosis and treatment.

Interestingly, treating some of the underlying causes can effectively reduce some of the symptoms and with continued support, the person’s condition can greatly improve . So, what are the causes of pseudodementia?

What is Pseudodementia?

What is Pseudeodementia Guide

When was the term pseudodementia first used?

Leslie Gordon Kiloh was an Australian doctor who was born in London in 1917. He completed his medical training at King’s College, London and after the Second World War he returned to the hospital and worked in the Neurology Department with some of the UK’s most eminent neurologists.

Kiloh wrote a number of influential papers on depression and the classification of depressive illnesses during his time at King’s College .

‘The term pseudo-dementia (PDEM) was coined by Kiloh (1961) to describe the cases, which closely mimicked the picture of dementia’. The National Library of Medicine

The National Library of Medicine continues by explaining that the term –

‘has been used a little loosely for describing the cognitive deficits in depression, especially, which is found in old age’.

What is pseudodementia? – understanding the symptoms

symptoms of pseudodementiaPseudodementia can certainly appear very similar to dementia, but importantly, is not caused by neurological degradation. Commonly it has its roots in a mood-related condition such as depression and these conditions can be treated.

A patient with pseudodementia can have the following symptoms:

  • Difficulties with speech and words
  • Lapses of memory or memory loss
  • Difficulty keeping focused on something
  • Difficulty moderating their emotions
  • Struggle with being organized and unable to plan

All of the above symptoms are also commonly found in people with dementia which makes it very difficult for a doctor to make an accurate diagnosis.

If a person is presenting with these symptoms, but they are linked to depression, they may well have some of the following symptoms too:

  • A loss of interest in their favourite activities and pastimes
  • Period of feeling blue that last for a number of weeks each time
  • No interest in being sociable and seeing friends
  • Have suicidal thoughts
  • Suffer from insomnia or hypersomnia (excessively tired during the day and
    sleeping many hours at night)
  • A marked loss of appetite

This medical condition does occur in people as they age. Many doctors believe that depression can also cause cognitive impairment. It is well known that dementia can also cause depression.

As well as depression, there are several other mental conditions that can cause similar symptoms that need careful diagnosis.

What is pseudodementia? – getting a diagnosis

what is pseudodementia diagnosisNot surprisingly, doctors find it incredibly difficult to differentiate between dementia and pseudodementia. As they are often trying to make the diagnosis with an older patient, this can make it even harder. In addition, some doctors feel that the term ‘pseudodementia’ describes the symptoms and is not the correct name for the condition.

Doctors usually try to rule out all other medical conditions before they consider whether their patient could have pseudodementia. This usually takes time as the doctor wants to discount a number of cognitive impairments first.

To make the diagnosis even more challenging, their patient could have both dementia and depression at the same time. So, a number of tests need to be carried out.

‘Pseudodementia is a term used to describe patients who appear to be demented but are actually severely depressed.

Differences from genuine dementia can be subtle; patients with pseudodementia usually have a pre-existing history of depression with acute onset (often after a specific event), emphasize and appear more distressed about the cognitive deficits, and have preserved attention.

If the diagnosis of depression is suspected, patients should be asked about thoughts of suicidality and their social support structure.

Appropriate consultation and follow-up with a psychiatrist or social worker or hospitalization may be necessary to ensure the patient’s safety’     

Source: Sciencedirect.com

Diagnostic tests

The tests that the doctor will want to complete usually include :

  • The use of speech and language
  • Visual perception
  • Problem solving skills and other cognitive tests
  • Attention span and difficulties
  • Movement and balance

Blood tests are usually carried out to ensure that the patient does not have an underactive thyroid or Vitamin B12 deficiency. Both of these conditions can cause a number of similar symptoms to pseudodementia.

A brain scan is the most important test to have done as the results for dementia or pseudodementia will be very clearly different because of the changes in brain structure and function found in people with dementia.

According to the Healthline website, in people with dementia, there can be 10-50% loss of brain volume.

Interestingly, family members may spot a difference in their loved ones behaviour. People with dementia usually try to hide any memory loss. However, people with pseudodementia may well highlight their difficulties.

Treating pseudodementia

What is pseudodementia treatmentOnce the doctor has made the diagnosis of pseudodementia, they will be keen to start treatment to address the underlying cause which is usually depression.

Depression can be successfully minimised but the treatment must be tailor-made for the individual and usually comprises of both psychotherapy sessions and medication.

A popular type of therapy used is Cognitive Behavioural Therapy (CBT) and the suggested medication may be a course of antidepressants.

Unfortunately, at present there is no cure for dementia, but the symptoms of dementia can be managed for a while.

With cases of pseudodementia, treatment of the underlying depression, often results in a significant improvement in the patient’s condition if not a total reversal in their symptoms.

‘Across multiple studies, between 10%- 90% of people who were at one time diagnosed with pseudodementia were later found to have irreversible or neurodegenerative forms of dementia’. Healthline .com

If you enjoyed reading our blog on ‘What is Pseudodementia’ then you may also find value in our other article that gives an overview of pseudodementia.

Pseudodementia – An Overview


Leslie Kiloh, a psychiatrist, came up with the term Pseudodementia (PDEM) in 1961.

In short, describes a range of dementia-like symptoms.

These may include hysteria, depression, and schizophrenia.

Experts agree that depression is the major culprit that makes people feel as though they have dementia.

Also known as depression-related cognitive dysfunction, there are three primary cognitive components that Pseudodementia involves:

I. Deficits in executive functioning
II. Problems with memory
III. Challenges with language and speech

People who go through this worry too much about their experience a high percentage assuming that they have dementia.

Thankfully, this is not the case because the psychiatric conditions that a person goes through while dealing with this form of cognitive impairment are reversible through treatment.

If the treatment of depression, hysteria, or schizophrenia is successful, then the cognitive symptoms also go away.

Pseudodementia Background

Even though people were using the term Pseudodementia before, it was not until Kiloh published a paper titled “Pseudo-dementia” in 1961 that many others took up interest.

The Scientific journal Acta Psychiatrica Scandinavica published her paper that presented vignettes of ten people a majority with depressive features.

This sparked a huge debate opening up areas of scientific study and research examining whether it is possible to reverse cognitive deficits in depression cases and whether these end up causing dementia in the long-run.

Symptoms of Pseudodementia

symptoms of pseudodementia
Persons with PDEM might experience a wide range of symptoms. Most of these usually overlap with those of individuals with dementia.

Examples of the symptoms may include:

  • Anxiety
  • Delayed motor response
  • Difficulty making decisions or completing tasks
  • Trouble remembering things
  • Difficult times communicating with others
  • Lower processing speed
  • Feelings of hopelessness and helplessness
  • Hypersomnia or insomnia
  • Fatigue
  • Loss of appetite or overeating
  • Suicide thought
  • Cognitive impairment is mostly seen in middle-aged and older adults


There have been very many misdiagnosis cases of people who have Pseudodementia because a majority usually conclude that they have dementia. Thus, start getting into a lifestyle to manage the illness because it still has no cure.

This is especially in cases that touch on elderly persons who experience negative changes in behavior or thinking.

Statistics suggest that between 2-32% of seniors who experience cognitive problems may not have dementia.

Proper diagnosis is also tricky because some older adults can experience both PDEM and dementia.

It is, therefore, crucial for a person to go through an extensive clinical interview. This helps to reveal essential clues that professionals can use for proper diagnosis.

A GDS (Geriatric Depression Scale) may also be necessary. It can help differentiate between dementia and other forms of cognitive disorders.

Most of the time, medics and geriatricians will combine this with current functioning and medical history to come up with a diagnosis.

Treatment Options for Pseudodementia

treatment options for pseudodementia
It is important to note that even though this is a reversible cognitive disorder, treating it is still complex.

This type of cognitive dysfunction requires a combination of treatment modalities that may include psychotherapy, drugs, or a combination of both.

Various treatments can help with this condition such as:

1. CBT (Cognitive Behavioural Therapy)

CBT cognitive behavioural therapy
This generally seeks to enhance the mood of a person going through conditions like depression. It involves the changing and exploring of behaviors as well as thought patterns.

2. Interpersonal Therapy

interpersonal therapy
The other treatment option that experts recommend is interpersonal therapy. This mostly focuses on the relationships of the impaired individual.

Professionals seek to identify if these have any link between the relationships and feelings of depression.

3. Antidepressants

Some antidepressant drugs can help to eliminate cognitive dysfunction brought about by depression.

Keep in mind that depression has different causes; thus, treatment may vary from one person to the next, depending on what is most suitable.

How PDEM differs From Dementia

how PDEM differs from dementia
There are clear differences between dementia and cognitive impairment that mimics the illness.

This is one of the factors that can help to reduce misdiagnosis.

For instance, when looking at the history of dementia, you will notice that it is stealthy while this cognitive decline is quick and short.

Doctors usually test the memory of individuals to know whether they have reversible cognitive impairment or dementia.

This may involve asking several questions. For persons with this depression-related cognitive dysfunction, the answer will always be they do not know.

Concentration and attention, however, are usually intact though affected persons may appear as though they are upset.

It is a different case with dementia because individuals with the illness have poor concentration and attention, give out wrong answers, and typically appear like they are unconcerned.

Persons with PDEM might also complain about their memory but do reasonably well when it comes to mental status tests and exams that evaluate cognitive function.

On the other hand, people with dementia may deny experiencing any memory problems, but they do not do well with cognitive exams.

Most people with the reversible cognitive disorder will not show signs of severe mood swings.

The opposite is true for people with dementia because many showcase an extensive range of emotions where some have inappropriate responses like crying when everyone else is laughing.


If you found value in this article, then you may also enjoy reading our other article titled What is Pseudodementia?

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