8. The Diagnostic Challenge: Peeling Back the Layers
Pseudodementia presents a unique diagnostic challenge to healthcare professionals. The overlapping symptoms with true dementia, the predominant effect on the elderly, and the subtle nuances in symptom presentation all contribute to the diagnostic puzzle of pseudodementia.
In the first instance, the overlap of symptoms with dementia is a major hurdle. Both conditions present with cognitive impairment, and disentangling the cause can be difficult. However, one key difference to note is the progression of symptoms. In dementia, cognitive decline progresses over time, while in pseudodementia, cognitive impairment is generally consistent with fluctuations based on mood state.
Secondly, the age factor adds complexity to the diagnosis. As pseudodementia predominantly affects older adults, its symptoms can be easily mistaken for ‘normal’ aging or other common conditions in this age group, such as dementia or Alzheimer’s disease.
Lastly, the interplay between mood and cognitive symptoms is a crucial diagnostic clue. Unlike dementia, where cognitive symptoms precede mood changes, pseudodementia often presents with mood symptoms before cognitive decline. This reversed order of symptom presentation can serve as a valuable pointer towards a correct diagnosis of pseudodementia. (8)
