Features that help distinguish between dementia and pseudodementia2 18 23 28 32 33 39
| Pseudodementia | Dementia |
| Abrupt onset, usually within days or weeks | Insidious, subtle onset |
| Rapid symptom progression Symptoms of short duration and more severe in the morning | Progression of symptoms is slow, gradual Long-term symptomatology with nocturnal worsening |
| Family aware of the onset of symptoms | Family initially unaware of disabilities/deficits |
| Personal history of depressive or manic episodes often | Rarely with personal history of mood disorders |
| Family history of mood disorders | Family history of dementia often |
| Depressed mood; little or no reaction to sad or funny situations; behaviour and affects are inconsistent with the degree of cognitive impairment | Superficial or labile mood; normal or exaggerated response to sad or funny situations; affects are consistent with the degree of cognitive impairment |
| Poor collaboration; little effort to perform well; often tends to give up; often responds with “I don’t know”; apathetic, emphasises failure | Good collaboration; frustrated/reacts catastrophically to error/inability to do well; emphasises performing trivial activities |
| Highlights memory loss; disturbed by memory lapses but performing well on cognitive tests; greater impairment of personality characteristics (eg, self-confidence, motivation, interests and attention) | Denies, hides and minimises difficulties/deficits; poor performance on cognitive tests; greater impairment in cognitive characteristics (recent memory and temporal orientation) |
| MMSE with variable results at different times | MMSE with stable result (low score) |
| Predominance of psychological symptoms: sadness, anxiety, somatic symptoms | Predominance of neurological symptoms: dysphasia, dyspraxia, agnosia, incontinence |
| CT: usually little evidence of atrophy | CT: atrophy and enlargement of the ventricles |
| EEG: normal | EEG: pronounced slow activity |
| SPECT: normal blood circulation pattern | SPECT: parietotemporal and frontal abnormalities often |
| Good prognosis | Poor prognosis |
| Usually responds to treatment with antidepressants and/or electroconvulsive therapy | Incurable; treatment consists of controlling symptoms |
CT, computed tomography; EEG, electroencephalogram; MMSE, Mini Mental State Examination; SPECT, single-photon emission CT.