11 Differences Between Dementia And Pseudodementia

Do you know the differences between dementia and pseudodementia? Here we leave you up to a total of 11, in addition to a definition of each of these pathologies.

Before delving into the differences between dementia and pseudodementia, we are going to briefly define what each of these diagnoses consists of. Dementia, also known as major neurocognitive disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), manifests as a significant alteration, with respect to the previous level of performance, in one or more cognitive domains (attention, cognitive functioning , language, learning and memory, etc.).

That is, in dementia (which can be due to multiple causes – Alzheimer’s disease, Parkinson’s disease, Lewy body disease, vascular, etc.) – there is a progressive loss of cognitive functions. On the other hand, pseudodementia implies the presence of demential symptoms, but as a result of a functional psychopathological picture (the most frequent: major depression).

In other words, in pseudodementia there is no real dementia, but the loss or alteration in cognitive functions arises from the underlying mental disorder itself. In depression, for example, we can identify memory function similar to that found in the early stages of dementia. Are they typical symptoms of dementia? Yes. Is it really dementia? No.

The differences between dementia and pseudodementia

How to make a good differential diagnosis? What differences between dementia and pseudodementia do we find? We leave you the most significant:

Beginning and evolution

One of the first differences between dementia and pseudodementia has to do with the onset of symptoms or pathology. Thus, while in dementia the onset is poorly defined and its onset is slow and progressive, in the case of pseudodementia its onset is well defined and the onset of the symptoms is abrupt.

Regarding evolution, we also find differences. In dementia the deterioration is progressive and in pseudodementia, it is uneven.

Furthermore, while in dementia the symptoms cannot be “cured” (although their appearance can be slowed down, through cognitive stimulation, for example), in pseudodementia the symptoms can be “cured” (when the psychopathological disorder of base that originates the symptoms).

Disease awareness

In dementia, patients are not usually aware of the disease ; that is, it is non-existent. In contrast, in pseudodementia, patients are aware of their symptoms (awareness of the disease is very marked).

The symptoms and difficulties caused by dementia are generally not recognized by the patient himself. On the other hand, in pseudodementia they are almost always well identified by the patient himself (in addition to that he usually experiences them very badly).

Humor

In humor we find another of the differences between dementia and pseudodementia. Thus, while in patients with dementia it is labile or inadequate, in patients with pseudodementia, humor is usually absent or very flat (largely due to their great awareness of their symptoms).

Attention

Attention is an indispensable cognitive skill for many other functions (it allows us to think, attend, focus our resources on a certain stimulus or task and, ultimately, learn). Attention in people suffering from dementia is usually deficient. On the other hand, in people with pseudodementia, it is preserved quite well.

Short-term and long-term memory

Another cognitive domain, in this case short-term memory (CCM), would constitute another of the differences between dementia and pseudo-dementia. In the case of dementia, short-term memory is always affected, whereas in people with pseudodementia, it is only diminished occasionally.

Regarding long-term memory (LTM), another of the cognitive domains or functions, we find that people with dementia suffer from progressive memory failure (which worsens over time). In contrast, in people with pseudodementia, the MLP is altered (and almost always, inexplicably).

Language

Another important area on a cognitive level: language. People with dementia typically suffer from a condition called anomia, which prevents them from calling things by name. In other words, the person cannot find the words to name the reality that they knew before. On the other hand, in pseudodementia there are usually no alterations in language.

Conduct

In relation to behavior, this is usually consistent with the deficit that the person presents in the case of dementia ; in this case, the behavior is usually focused on compensating the deficits. On the other hand, in pseudodementia, the behavior is usually one of abandonment and is not consistent with the deficit suffered by the patient.

Social decline

Social relationships are also altered in this type of pathology. Thus, the social deterioration in dementia is slow. On the other hand, in pseudodementia it is usually rather early (and faster).

Clinic

In the case of dementia, the symptoms are consistent with the dementia itself. In addition, there is a nocturnal aggravation of symptoms. The impact on the performance of the person is global, and imprecise complaints appear (and less than objectified).

On the other hand, in pseudodementia the clinic is incongruous with what happens to the person (who does not really have dementia), and symptoms are usually exaggerated. In this case, more complaints appear than can be objectified, unlike what happens with dementia. Finally, in pseudodementia the complaints are more specific than in dementia.

Response to tests

Another difference between dementia and pseudodementia refers to the response to the tests. In people with dementia, the following occurs:

Good cooperation.
Proof of results.
They produce little anxiety.
Evasive, wrong, conniving or persistent responses.
The person highlights the successes.

Instead, what happens in the evaluation of a person with pseudodementia? In broad strokes, the following:

Little cooperation.
Variable success.
They produce anxiety.
Uninteresting, global, “I don’t know” answers.
The person highlights the flaws.

Response to antidepressant treatment

Finally, the last of the differences between dementia and pseudodementia that we find is the response to antidepressant treatment. In dementia, the response to it is usually poor (in terms of cognitive symptoms, not depressive symptoms); On the other hand, in pseudodementia the answer is good (also referring only to cognitive symptoms).

In the case of pseudodementia, curiously, when the depressive symptoms are reduced thanks to the antidepressant drug, the cognitive symptoms also improve (which would explain that it is a pseudodementia, because the cognitive symptoms appear due to the depression itself).

Know the differences for a good diagnosis

We have seen the most striking differences between dementia and pseudodementia. And it is that we must be clear that the cognitive symptoms of dementia do have an organic origin (they are due to the dementia itself), and that the cognitive symptoms of pseuodementia, on the other hand, are explained by a basic psychological disorder (which frequently is depression).

Knowing these differences will help us to make a good differential diagnosis and to design a personalized intervention for the needs of our patients. Beyond the medical or psychological field, knowing the differences can help us understand family or friends who present one of these two conditions.