An elderly woman referred for evaluation of suspected Alzheimer disease gives 'I don't know' answers to most cognitive questions, makes minimal effort at testing, and complains prominently about her memory. Her family notes the decline began abruptly around the death of her spouse. Which pattern BEST distinguishes depressive pseudodementia from true dementia?

• A Patients with pseudodementia perform worse on delayed recall than on attention tasks
• B Patients with pseudodementia have insidious onset over years, while dementia begins abruptly
• C Patients with pseudodementia minimise their deficits, while demented patients exaggerate them
• D Patients with pseudodementia give 'I don't know' answers, while demented patients typically confabulate and try hard to answer ✓

Explanation

In depressive pseudodementia the patient complains loudly about memory, gives 'I don't know' responses, exerts poor effort, and has abrupt onset often linked to a life event, whereas the demented patient conceals deficits, confabulates to fill gaps, and struggles visibly on every item. Onset in dementia is insidious over years, the reverse of option B. Attention tends to be impaired early in depression while delayed recall is relatively preserved until late.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.