Zimpapers Logo

Dr Sacrifice Chirisa Mental Health Matters
Last week, I looked at dementia. With this in mind, I have seen it fit to discuss false or better known as pseudo-dementia; the primary reason being why accurate diagnosis is so important among people exhibiting cognitive problems is that some causes of cognitive impairment are reversible.

Considering the costs, physically, emotionally, and financially of diagnosing someone with irreversible dementia when, in fact, the problem could have been reversed.

Pseudo-dementia is a situation where a person who has depression also has cognitive impairment that looks like dementia. Depression is a mental disorder that includes a depressed mood that lasts at least two weeks accompanied by the loss of interest, or pleasure, in nearly all activities, feelings of guilt or suicide, social withdrawal, and sleep and appetite disturbances.

Depression can also create cognitive symptoms such as difficulty in thinking clearly, problems concentrating, and difficulty in making decisions. Pseudo-dementia is not permanent; once a person’s depression is successfully treated, his or her cognitive symptoms will go away as well.

Between two percent and 30 percent of older individuals, who experience cognitive problems, actually have pseudo-dementia. It is often tricky to distinguish between depression and dementia in older adults. A thorough clinical interview can reveal important clues about the proper diagnosis. For instance, while people with depression may complain of having memory problems and appear upset about them, they will usually perform well on objective neuropsychological tests of memory administered in a clinician’s office. On the other hand, individuals with dementia will often deny having any problems with memory or minimise their importance, and display impairment on neuropsychological tests.

A Geriatric Depression Scale (GDS) is often used to help differentiate between pseudo-dementia and other forms of dementia. Results from the GDS are combined with other information about a person’s history and current functioning to help with diagnosis. For example, people with pseudo-dementia typically do not have a history of mood swings (unless they have bipolar disorder, an illness characterised by repetitive swings in mood and energy levels) and are likely to score high (high = more depressed) on the GDS. In contrast, people with dementia usually show a range of emotions, sometimes responding to situations with an inappropriate emotion (e.g., laughing while others are sad).

Although pseudo-dementia is reversible, treating it can be as complex as treating “regular dementia,” requiring a flexible approach and multiple treatment modalities (e.g., medication, psychotherapy, or a combination of both). Depression has multiple potential causes, therefore, which treatments or combinations of treatments will be effective tends to vary across individuals.

Medications to treat depression include selective serotonin re-uptake inhibitors like fluoxetine, which raises the overall level of the neurotransmitter serotonin. These medications have different potential side effects and should be used in consultation with a psychiatrist. Psychotherapy either individually or in a group, and working on strategies to help manage or reduce depressive symptoms.

Depression is often successfully treated; however, symptoms including cognitive impairment typically do not go away immediately. Both medications and psychotherapy techniques may require several weeks before providing a noticeable decrease in symptoms.

In addition, people who have depression may experience relapses.

Dr Sacrifice Chirisa is a passionate mental health specialist based at Parirenyatwa Group of Hospitals, one of the country’s major referral hospitals.