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Forgetting a name occasionally is normal, but repeatedly losing track of conversations, struggling to concentrate or saying "my memory is failing" can feel far more alarming, particularly in later life. However, not every apparent memory disorder is dementia. Depression, prolonged stress, poor sleep and other reversible conditions can produce striking cognitive symptoms, a presentation historically called pseudodementia. The term is useful, but medically imperfect.
Pseudodementia is not regarded as a proper diagnosis, but this doesn't mean that the related symptoms are merely fictitious. It is well-known that depression can indeed affect cognitive abilities connected with attention and speed of information processing, executive functions and memory. By executive functions, we mean the mental processes responsible for organizing and prioritizing, starting and completing a task. It is logical that if attention is defective, the information does not get properly encoded and, consequently, cannot be easily retrieved.
The pattern of symptoms often provides important clues
Depression-related cognitive impairment may develop over weeks or months, and patients are usually very aware of the problem. They may repeatedly complain about their forgetfulness, become distressed during testing or answer "I don't know" despite having the ability to attempt a task. Their performance can also fluctuate. By contrast, neurodegenerative dementia such as Alzheimer's disease typically develops insidiously, progressing gradually. Early Alzheimer's disease often affects the ability to learn and retain new information, with deficits becoming increasingly consistent.
Mood symptoms afford another important clue. Some of the key warning signs for possible depression include feeling sad all the time, losing interest in life, experiencing extreme tiredness, feeling guilty, withdrawing from others, and having trouble sleeping or eating. Yet it should be noted that the difference between the two conditions is not always clear-cut. Indeed, depression may accompany or even precede a neurodegenerative disorder. Modern evidence therefore treats "pseudodementia" cautiously rather than assuming cognitive symptoms will disappear once mood improves.
Assessment should begin with a detailed history
When assessing cognitive symptoms, doctors consider when they started, how quickly they changed, medication use, sleep, mood, daily functioning, and what family members have observed. Cognitive screening may be followed by formal neuropsychological testing, which examines memory, attention, language and executive abilities. Blood tests and, when indicated, brain imaging can help identify other contributing factors.
Memory changes need a closer look
It is crucial to pay attention to memory issues, but at the same time, these issues should not be perceived as cases of dementia. The treatment of depression, better sleep and reconsideration of the medications that may impact mind work can lead to positive outcomes. Meanwhile, steady decline in memory should not be considered as "due to stress". Family members may notice that for them it is much more significant to see that a person cannot perform well in daily tasks, conversations, and routines than to be informed about their occasional forgetfulness. A complete evaluation will help to answer the question of whether the cognitive changes are curable or signify the need of the future following up on the illness.
(By Dr Atampreet Singh, Senior Director & Head, ShardaCare-HealthCity)
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