depression_vs_dementia_flashcards
What is the history and onset for depression compared to dementia?
Depression: short history, rapid onset. Dementia: longer history, gradual onset.
What biological symptoms suggest depression over dementia?
Depression: weight loss, sleep disturbance. Dementia: typically lacks biological symptoms.
How does patient concern differ between depression and dementia?
Depression: patient worried about poor memory. Dementia: patient often unaware or unconcerned about memory issues.
How does willingness to take tests differ between depression and dementia?
Depression: reluctant to take tests, disappointed with results. Dementia: more willing to take tests, may be unaware of poor performance.
What is the pattern in mini-mental test scores for depression compared to dementia?
Depression: variable. Dementia: consistently low.
What type of memory loss is characteristic of depression vs. dementia?
Depression: global memory loss. Dementia: recent memory loss.
summarise Depression vs. dementia
Depression vs. dementia
Factors suggesting diagnosis of depression over dementia
short history, rapid onset
biological symptoms e.g. weight loss, sleep disturbance
patient worried about poor memory
reluctant to take tests, disappointed with results
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)
A 60-year-old-male goes to his GP complaining of forgetfulness for the past 2 months. He has difficulty remembering details such as leaving the kettle on and where he left his keys. He works as the director of a pharmaceutical company and describes stress at work. He also has difficulty sleeping at night. His mini mental state examination (MMSE) score is 26 out of 30. Patient answered ‘I don’t know’ to the last two letters when asked to spell WORLD backwards. His medical history includes hypertension and gout.
What is the most likely diagnosis?
Alzheimer’s disease
Fronto-temporal dementia
Vascular dementia
Parkinson’s disease
Depression
Depression
Sleep disturbance, stress triggers and normal mini-mental test score with global memory loss suggests depression rather than dementia
This is more likely a case of pseudodementia secondary to depression. Once the patient’s depression is managed, his cognitive impairment will be reversed.
A 71-year-old woman with a history of type 2 diabetes and angina presents to the GP alongside her daughter, who is worried about her mother’s memory. Exploring this further, you note this has been developing over the last 7 months since her husband passed away and has been accompanied by difficulty sleeping. The patient is very worried about her memory loss, particularly as she is having increasing difficulty remembering events from her childhood. Her daughter notes her granddad (her mother’s father) suffered from dementia.
What is the most likely diagnosis?
Alzheimer’s dementia
Frontotemporal dementia
Normal grief reaction
Pseudodementia
Vascular dementia
Pseudodementia
Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss - this is called pseudodementia
Pseudodementia is the correct answer. In older patients presenting with memory loss, dementia is a key differential, with several different subtypes to be aware of. However, it is also important to know that in older people, depression can also be a cause of memory loss- known as pseudodementia- where the underlying cause of the dementia has no neurodegenerative basis. While it is sometimes difficult to diagnose, there are some clues in this history to point towards it. The recent bereavement of her husband is a possible trigger for a depressive episode. There is a rapid onset of symptoms, which include global memory loss- meaning there is also loss of long-term memories, compared to most forms of dementia where short-term memory is affected first. There are also usually accompanying biological symptoms like sleep disturbances. These patients can have insight into their cognitive decline, and this is often very worrying for the patient- and can mean they are reluctant to undergo further tests. While some risk factors for vascular dementia (age/diabetes/angina) and a positive family history of Alzheimer’s are present, these are generally quite common conditions, and without any other characteristic features of these diseases present, pseudodementia is the most likely diagnosis.
Alzheimer’s dementia is incorrect. This is the most common form of dementia, associated with the build-up of amyloid and tau proteins in the brain. While there is a positive family history, in Alzheimer’s symptoms usually come on more gradually than 2 months- often over years. Additionally, short-term memory is affected first, so you would not expect this patient to have difficulty recalling childhood memories.
Frontotemporal dementia is incorrect. This is a more uncommon form of dementia, previously known as ‘Pick’s disease’, which affects the frontal and temporal lobes. It tends to come on in younger age ranges (usually between 45-65) and commonly causes changes in behaviour and language. These personality changes tend to occur first, only followed later by memory loss- and so is unlikely in this patient.
Normal grief reaction is incorrect. A normal grief reaction can affect memory, cognition, and concentration, with these symptoms being most concentrated in the first 6 months after a bereavement. However, you would not expect these symptoms of global memory loss to persist past 6 months in a normal grief reaction, and therefore this option is incorrect.
Vascular dementia is incorrect. This is a form of dementia caused by a dysregulation of blood flow to the brain- often with a series of strokes causing cognitive decline. The main symptoms tend to be issues with problem-solving and speed of thought, but memory is also affected. Multiple risk factors including high cholesterol, diabetes, and previous ischaemic events are often present, and cognitive ability often declines in a stepwise fashion due to successive cerebrovascular events.
