A 72-year-old retired teacher presents with a 3-month history of cognitive decline with prominent memory complaints, psychomotor retardation, and refusal to attempt tasks. Her family notes she was recently widowed. Neuropsychological testing shows variable performance with effort-dependent failures. She scores 26/30 on MMSE when encouraged. Her CT brain is normal. The MOST likely diagnosis is:
- A Depressive pseudodementia (depression-related cognitive dysfunction) ✓
- B Early Alzheimer's disease with depression
- C Vascular dementia
- D Frontotemporal dementia
Explanation
Depressive pseudodementia (now termed 'depression-related cognitive dysfunction') typically features: acute/subacute onset after an identifiable stressor (bereavement), patient actively complaining of memory loss (unlike Alzheimer's where insight is lost), variable performance on effort-dependent testing, preserved cognitive abilities when encouraged, and normal or near-normal MMSE. Alzheimer's shows progressive decline with loss of insight; vascular dementia is associated with step-wise decline and vascular risk factors/imaging changes; frontotemporal dementia presents with behaviour/personality change rather than memory complaints.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.