A 72-year-old retired teacher presents with 3-month history of poor memory, poor concentration, and inability to manage his finances. He is deeply distressed and answers 'I don't know' to most cognitive questions. MMSE is 18/30. His wife notes he has also lost interest in all activities he previously enjoyed. His symptoms improve with a trial of antidepressant. What is the MOST likely diagnosis?
- A Depressive pseudodementia ✓
- B Alzheimer's disease
- C Vascular dementia
- D Normal pressure hydrocephalus
Explanation
Depressive pseudodementia (now termed 'depression-executive dysfunction syndrome' or 'dementia of depression') presents in elderly patients with cognitive deficits that mimic true dementia but are secondary to depression. Key features differentiating it from true dementia: patient is distressed about cognitive failure (rather than indifferent), 'I don't know' responses predominate (rather than confabulation), short history (weeks to months), prominent dysthymia and anhedonia, and reversibility with antidepressant treatment. Neuropsychological testing shows inconsistent effort. It carries a 40–50% risk of converting to true dementia over 5–10 years, however, so long-term monitoring is essential.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.