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Longitudinal outcomes of patients with pseudodementia: a systematic review

Published online by Cambridge University Press:  15 October 2018

Michael H. Connors ,
Lena Quinto  and
Henry Brodaty
Michael H. Connors
Affiliation:
Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, Australia Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia lllawarra Shoalhaven Local Health District, Wollongong, Australia
Lena Quinto
Affiliation:
lllawarra Shoalhaven Local Health District, Wollongong, Australia
Henry Brodaty*
Affiliation:
Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, Australia Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia
*
Author for correspondence: Henry Brodaty, E-mail: h.brodaty@unsw.edu.au
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Abstract

Depression and a number of other psychiatric conditions can impair cognition and give the appearance of neurodegenerative disease. Collectively, this group of disorders is known as ‘pseudodementia’ and are important to identify given their potential reversibility with treatment. Despite considerable interest historically, the longitudinal outcomes of patients with pseudodementia remain unclear. We conducted a systematic review of longitudinal studies of pseudodementia. Bibliographic databases were searched using a wide range of search terms. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 18 studies with follow-up varying from several weeks to 18 years. Overall, 284 patients were studied, including 238 patients with depression, 18 with conversion disorder, 14 with psychosis, and 11 with bipolar disorder. Irrespective of diagnosis, 33% developed irreversible dementia at follow-up, 53% no longer met criteria for dementia, and 15% were lost to follow-up. Considerable variability was identified, with younger age at baseline, but not follow-up duration, associated with better outcomes. ECT and pharmacological interventions were also reported to be beneficial, though findings were limited by the poor quality of the studies. Overall, the findings suggest that pseudodementia may confer an increased risk of irreversible dementia in older patients. The findings also indicate, however, that a significant proportion improve, while many remain burdened with their psychiatric condition, independent of organic dementia. The findings support the clinical value of the construct and the need for its re-examination in light of developments in neuroimaging, genomics, other investigative tools, and trial methodology.

Keywords

Alzheimer's diseasedementiadepressionlongitudinalpseudodementiareversible dementiasystematic review
Type
Review Article
Information
Psychological Medicine , Volume 49 , Issue 5 , April 2019 , pp. 727 - 737
Copyright
Copyright © Cambridge University Press 2018 

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References

Alexopoulos, GS (2003) Depressive dementia: cognitive and biological correlates and course of illness. In Oxman, TE and Emery, VOB (eds), Dementia: Presentations, Differential Diagnosis and the Nosology, 2nd edn. Baltimore, USA: The Johns Hopkins University Press, pp. 398–416.Google Scholar
Alexopoulos, GS, Meyers, BS, Young, RC, Mattis, S and Kakuma, T (1993) The course of geriatric depression with “reversible dementia”: a controlled study. American Journal of Psychiatry 150, 1693–1699.Google Scholar
Allen, RM (1982) Pseudodementia and ECT. Biological Psychiatry 17, 1435–1443.Google Scholar
Almeida, OP, Ford, AH, Hankey, GJ, Yeap, BB, Golledge, J and Flicker, L (2018) Risk of dementia associated with psychotic disorders in later life: the health in men study (HIMS). Psychological Medicine, Advance online publication 1–11.Google Scholar
Andersen, G, Vestergaard, K, Riis, JØ and Ingeman-Nielsen, M (1996). Dementia of depression or depression of dementia in stroke? Acta Psychiatrica Scandinavica 94, 272–278.Google Scholar
Armijo-Olivo, S, Stiles, CR, Hagen, NA, Biondo, PD and Cummings, GG (2012) Assessment of study quality for systematic reviews: a comparison of the Cochrane collaboration risk of bias tool and the effective public health practice project quality assessment tool: methodological research. Journal of Evaluation in Clinical Practice 18, 12–18.Google Scholar
Berrios, GE (1985) Depressive “pseudodementia” or “melancholic dementia”: a 19th century view. Journal of Neurology, Neurosurgery, and Psychiatry 48, 393–400.Google Scholar
Bieniek, KF, van Blitterswijk, M, Baker, MC, Petrucelli, L, Rademakers, R and Dickson, DW (2014) Expanded C9ORF72 hexanucleotide repeat in depressive pseudodementia. JAMA Neurology 71, 775–781.Google Scholar
Bora, E, Harrison, BJ, Yücel, M and Pantelis, C (2012) Cognitive impairment in euthymic major depressive disorder: a meta-analysis. Psychological Medicine 43, 2017–2026.Google Scholar
Brenner, RP, Reynolds, CF III and Ulrich, RF (1989) EEG findings in depressive pseudodementia and dementia with secondary depression. Electroencephalography and Clinical Neurophysiology 72, 298–304.Google Scholar
Bulbena, A and Berrios, GE (1986) Pseudodementia: facts and figures. British Journal of Psychiatry 148, 87.Google Scholar
Burns, A and Jolley, D (2015) Pseudodementia: history, mystery and positivity. In Bhugra, D and Malhi, GS (eds), Troublesome Disguises: Managing Challenging Disorders in Psychiatry, 2nd edn. Oxford, UK: John Wiley & Sons, pp. 218–230.Google Scholar
Clarfield, AM (1988) The reversible dementias: do they reverse? Annals of Internal Medicine 109, 476–486.Google Scholar
Clarfield, AM (2003) The decreasing prevalence of reversible dementias: an updated meta-analysis. Archives of Internal Medicine 163, 2219–2229.Google Scholar
Copeland, JR, Davidson, IA, Dewey, ME, Gilmore, C, Larkin, BA, McWilliam, C, Saunders, PA, Scott, A, Sharma, V and Sullivan, C (1992) Alzheimer's disease, other dementias, depression and pseudodementia: prevalence, incidence and three-year outcome in Liverpool. British Journal of Psychiatry 161, 230.Google Scholar
da Silva, J, Gonçalves-Pereira, M, Xavier, M and Mukaetova-Ladinska, EB (2013) Affective disorders and risk of developing dementia: systematic review. British Journal of Psychiatry 202, 177.Google Scholar
Diniz, BS, Butters, MA, Albert, SM, Dew, MA and Reynolds, CF (2013) Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies. British Journal of Psychiatry 202, 329.Google Scholar
Effective Public Health Practice Project (2007) Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Available at http://www.ephpp.ca/tools.html (Accessed 5 January 2018).Google Scholar
Emery, VOB and Oxman, TE (2003) Depressive dementia: a “prepermanent intermediate-stage dementia” in a long-term disease course of permanent dementia? In Oxman, TE and Emery, VOB (eds), Dementia: Presentations, Differential Diagnosis and the Nosology, 2nd edn. Baltimore, USA: The Johns Hopkins University Press, pp. 361–397.Google Scholar
Grunhaus, L, Dilsaver, S, Greden, JF and Carroll, BJ (1983) Depressive pseudodementia: a suggested diagnostic profile. Biological Psychiatry 18, 215–225.Google Scholar
Helmchen, H and Linden, M (2008) The differentiation between depression and dementia in the very old. Ageing and Society 13, 589–617.Google Scholar
Hepple, J (2004) Conversion pseudodementia in older people: a descriptive case series. International Journal of Geriatric Psychiatry 19, 961–967.Google Scholar
Jones, RD, Tranel, D, Benton, A and Paulsen, J (1992) Differentiating dementia from “pseudodementia” early in the clinical course: utility of neuropsychological tests. Neuropsychology 6, 13–21.Google Scholar
Kiloh, LG (1961) Pseudo-dementia. Acta Psychiatrica Scandinavica 37, 336–351.Google Scholar
Koskinen, T (1992) Pseudodementia as manifestation of depression in the elderly. Psychiatria Fennica 23, 123–129.Google Scholar
Kral, VA (1982) Depressive pseudodemenz und senile demenz vom Alzheimer-type. Eine pilot-studie. Der Nervenarzt 53, 284–286.Google Scholar
Kral, VA (1983) The relationship between senile dementia (Alzheimer type) and depression. Canadian Journal of Psychiatry 28, 304–306.Google Scholar
Kral, VA and Emery, OB (1989) Long-term follow-up of depressive pseudodementia of the aged. Canadian Journal of Psychiatry 34, 445.Google Scholar
Lazare, A (1981) Current concepts in psychiatry: conversion symptoms. New England Journal of Medicine 305, 745–748.Google Scholar
Liberini, P, Faglia, L, Salvi, F and Grant, RP (1993a) Cognitive impairment related to conversion disorder: a two-year follow-up study. Journal of Nervous and Mental Disease 181, 325–327.Google Scholar
Liberini, P, Faglia, L, Salvi, F and Grant, RP (1993b) What is the incidence of conversion pseudodementia? British Journal of Psychiatry 162, 124.Google Scholar
Liguori, C, Pierantozzi, M, Chiaravalloti, A, Sancesario, G, Mercuri, N and Sancesario, G (2016) Cognitive decline and late-life depression in the elderly: Alzheimer's disease or pseudodementia? Journal of Alzheimer's Disease 52, S74.Google Scholar
Mahendra, B (1985) Depression and dementia: the multi-faceted relationship. Psychological Medicine 15, 227–236.Google Scholar
McNeil, JK (1996) Discriminative validity of clinical features and depression severity in the dementia syndrome of depression. Journal of the American Geriatrics Society 44, 1137–1139.Google Scholar
McNeil, JK (1999) Neuropsychological characteristics of the dementia syndrome of depression: onset, resolution, and three-year follow-up. The Clinical Neuropsychologist 13, 136–146.Google Scholar
McNeil, JK (2001) No mistaken identity: pseudodementia is real and treatable. Journal of the American Geriatrics Society 49, 492–493.Google Scholar
Moreno, AC and Martin, VP (1985) El uso del test de supresion de dexametasona en un estudio prospectivo de pseudodemencias. Actas Luso-Espanolas De Neurologia Y Psiquiatria 13, 27–35.Google Scholar
Parker, G (2005) Beyond major depression. Psychological Medicine 35, 467–474.Google Scholar
Pearlson, GD, Rabins, PV, Kim, WS, Speedie, LJ, Moberg, PJ, Burns, A and Bascom, MJ (1989) Structural brain CT changes and cognitive deficits in elderly depressives with and without reversible dementia (‘pseudodementia’). Psychological Medicine 19, 573–584.Google Scholar
Peritogiannis, V, Zafiris, S, Pappas, D and Mavreas, V (2008) Conversion pseudodementia in the elderly: a review of the literature with case presentation. Psychogeriatrics 8, 24–31.Google Scholar
Rabins, PV (1983) Reversible dementia and the misdiagnosis of dementia: a review. Psychiatric Services 34, 830–835.Google Scholar
Rabins, PV, Merchant, A and Nestadt, G (1984) Criteria for diagnosing reversible dementia caused by depression: validation by 2-year follow-up. British Journal of Psychiatry 144, 488.Google Scholar
Rapinesi, C, Serata, D, Del Casale, A, Kotzalidis, GD, Mazzarini, L, Fensore, C, Carbonetti, P, Scatena, P, Capezzuto, S, Moscati, FM, Brugnoli, R, Tatarelli, R and Girardi, P (2013) Depressive pseudodementia in the elderly: effectiveness of electroconvulsive therapy. International Journal of Geriatric Psychiatry 28, 435–438.Google Scholar
Reding, MJ, Haycox, J, Wigforss, K, Brush, D and Blass, JP (1984) Follow up of patients referred to a dementia service. Journal of the American Geriatrics Society 32, 265–268.Google Scholar
Reding, M, Haycox, J and Blass, J (1985) Depression in patients referred to a dementia clinic: a three-year prospective study. Archives of Neurology 42, 894–896.Google Scholar
Reifler, BV (2000) A case of mistaken identity: pseudodementia is really predementia. Journal of the American Geriatrics Society 48, 593–594.Google Scholar
Reifler, BV, Larson, E and Hanley, R (1982) Coexistence of cognitive impairment and depression in geriatric outpatients. American Journal of Psychiatry 139, 623–626.Google Scholar
Reynolds, CF III, Perel, JM, Kupfer, DJ, Zimmer, B, Stack, JA and Hoch, CC (1987) Open-trial response to antidepressant treatment in elderly patients with mixed depression and cognitive impairment. Psychiatry Research 21, 111–122.Google Scholar
Sachdev, PS and Kiloh, LG (1994) The nondepressive pseudodementias. In Oxman, TE and Emery, VOB (eds), Dementia: Presentations, Differential Diagnosis and the Nosology, 1st edn. Baltimore, USA: The Johns Hopkins University Press, pp. 277–297.Google Scholar
Sachdev, PS and Reutens, S (2003) The nondepressive pseudodementias. In Oxman, TE and Emery, VOB (eds), Dementia: Presentations, Differential Diagnosis and the Nosology, 2nd edn. Baltimore, USA: The Johns Hopkins University Press, pp. 417–443.Google Scholar
Sachdev, PS, Smith, JS, Angus-Lepan, H and Rodriguez, P (1990) Pseudodementia twelve years on. Journal of Neurology, Neurosurgery, and Psychiatry 53, 254–259.Google Scholar
Sáez-Fonseca, JA, Lee, L and Walker, Z (2007) Long-term outcome of depressive pseudodementia in the elderly. Journal of Affective Disorders 101, 123–129.Google Scholar
Sancesario, GM, Liguori, C, Nuccetelli, M, Martorana, A, Sancesario, G and Bernardini, S (2014) Discrimination of pseudodementia from Alzheimer's disease using CSF biomarkers. Clinical Chemistry and Laboratory Medicine 52, eA396–eA397.Google Scholar
Smith, JS and Kiloh, LG (1981) The investigation of dementia: results in 200 consecutive admissions. The Lancet 317, 824–827.Google Scholar
Snowdon, J (2011) Pseudodementia, a term for its time: the impact of Leslie Kiloh's 1961 paper. Australasian Psychiatry 19, 391–397.Google Scholar
Stoudemire, A, Hill, CD, Morris, R and Dalton, ST (1995) Improvement in depression-related cognitive dysfunction following ECT. Journal of Neuropsychiatry and Clinical Neurosciences 7, 31–34.Google Scholar
Tsiouris, JA and Patti, PJ (1997) Drug treatment of depression associated with dementia or presented as ‘pseudodementia’ in older adults with Down syndrome. Journal of Applied Research in Intellectual Disabilities 10, 312–322.Google Scholar
Wells, CE (1979) Pseudodementia. American Journal of Psychiatry 136, 895–900.Google Scholar