Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine
by Ron Sterling, M.D. -- October 2004
Strictly speaking, the diagnosis of "dementia" should be reserved for situations where there is a preponderance of evidence that a person's intellectual decline is related to the loss of brain cells. The most common conditions that result in brain cell degeneration are Alzheimer's Disease (AD), Dementia with Lewy Bodies, chronic low blood flow (blood vessel disease), small and large strokes (brain cell death due to blocked blood vessels or brain bleeding), Parkinson's Disease, and tumors.
Traditionally, the word "pseudodementia" has been reserved for a "false" dementia related to depression. However, geriatric psychiatrists are moving towards calling any easily-reversible dementia a pseudodementia. These "dementias" are called false because the symptoms and signs they produce are not the result of actual brain cell death and, if diagnosed in a timely manner, can generally be fixed.
A short list of conditions that can mimic dementia are depression, electrolyte disturbances (high blood calcium or high or low sodium), hypothyroidism, nutritional deficiencies (B12, folate), and normal pressure hydrocephalus. Certain medications can cause confusion in older adults such as high dosages of ibuprofen (Advil). Digoxin can cause dementia-like symptoms even if the blood digoxin level is only mildly high. Benadryl and other anticholinergic medications can interact to produce confusion.
The most common pseudodementia is related to depression. For an older parent who has had episodes of depression in the past, we may be alert to the possibility of a new depression. However, with a parent who has never been depressed before, it may not be the first thing we would think about. Because many of the conditions that produce pseudodementia also produce fatigue and lethargy, a "loss of motivation" does not necessarily point to depression.
One indication that depression may be the cause of a mental decline can be that the low mood starts before the cognitive changes show up. Depression in older people is often characterized by a consistent low mood, answering a lot of questions with "I don't know," and not even attempting to do things when asked. This could include not changing clothes and not bathing. The memory loss can be "spotty." Recent memory may be intact, but remote memory difficult, which is the opposite of a typical dementia memory profile.
A specialist cannot determine that the diagnosis of dementia is related to depression until they have ruled out other conditions by doing blood tests and making a list of all the prescription and over-the-counter medications being used. The diagnosis of normal pressure hydrocephalus is generally not considered unless an older adult is experiencing unsteady walking with short, slow steps, memory difficulties, and frequent urinary accidents.
You might wonder why mental decline seems more apparent in depressed older people than in depressed younger people. Even though we now know that the hippocampus is probably damaged in clinical depression no matter what our age, the apparent reason for an age-specific difference is that older people just do not have a lot of reserve hippocampus nerve cells.
I hope this is helpful. For more information about generally reversible dementias, please visit Aging Brain Web Page. -- Best wishes, Dr. Ron.
Ron Sterling, M.D. is a 64 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement
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RON STERLING, M.D.
General Psychiatry with Specialization in Adult Attention Deficit Disorder
Updated October 7, 2007
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