Alzheimers or Pseudodementia? - USMLE Forums
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  #1  
Old 07-21-2012
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Neuro Alzheimers or Pseudodementia?

82 year old woman is brought to the physician by her family because of a 6-week history of increasing forgetfulness. She is a retired schoolteacher. Her granddaughter is concerned because on several occasions she has left the stove on During conversations she has difficulty remembering past events and seems unconcerned about her memory lapses. The patient describes trouble sleeping and has had a a 4.5-kg (10-lb) weight loss over the past month. She has a history of similar symptoms 2 and 5 years ago that were successfully treated with medication. She appears unkempt and has poor personal hygiene. ALL LABS ARE NORMAL
Mental status examination shows psychomotor retardation, a flat affect, impaired ability to recall past events, and trouble repeating three numbers in sequence. She is unable to recall the names of recent presidents.


alzheimers or pseudodementia??




my confusion

cos of the history of improvement of past symptoms with rx., weight loss, sleep disturbances -- it seems like pseudodementia due to depression.

however what goes against pseudodementia.. it that the patient doesnt remember her memory defect. which is characteristic of the condition.

so which one is it?
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Old 07-21-2012
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It is pseudodementia.

Points in favor:

1. Short history (6 weeks)
2. Both remote and recent memory loss
3. Past history of depression
4. poor personal hygiene, flat affect, unkempt, trouble sleeping and weight loss over the past month.etc
5. No language disturbances

Quote:
82 year old woman is brought to the physician by her family because of a 6-week history of increasing forgetfulness. She is a retired schoolteacher. Her granddaughter is concerned because on several occasions she has left the stove on During conversations she has difficulty remembering past events and seems unconcerned about her memory lapses. The patient describes trouble sleeping and has had a a 4.5-kg (10-lb) weight loss over the past month. She has a history of similar symptoms 2 and 5 years ago that were successfully treated with medication. She appears unkempt and has poor personal hygiene. ALL LABS ARE NORMAL Mental status examination shows psychomotor retardation, a flat affect, impaired ability to recall past events, and trouble repeating three numbers in sequence. She is unable to recall the names of recent presidents.

Last edited by Novobiocin; 07-21-2012 at 06:21 PM.
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Old 07-22-2012
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but isnt it characteristic in these patients to be aware of the fact that they are having memory loss of some kind?
(irrespective of this question)
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Old 07-22-2012
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Quote:
Originally Posted by mbbs2010 View Post
but isnt it characteristic in these patients to be aware of the fact that they are having memory loss of some kind?
(irrespective of this question)
Yes, that is a characteristic feature but not a pathognomic feature since people with depression are unconcerned about everything. When deciding on the answer among the choices you have to find the points in favor and point against a particular diagnosis. Remember, they are asking for the "most likely" diagnosis. So, if most of the features fit and one doesn't then pick the one which fits the most features. Also, remember the basic rule, physical findings have more weight than history and test results have more weight than finding or history unless one of them is pathognomic.
Unfortunately the days of picking an answer based on the buzzwords are coming to an end and they want to test whether you know everything about a particular disease/management.
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Old 07-22-2012
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Pseudo dementia. Its not Alzheimer's because latter is diagnosis of exclusion. Through history patient getting her dementia okay on meds plus weight loss point to depression.

In practice too patient with Alzheimer's who are difficult to differentiate from depression are given trial of SSRI.
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Old 07-23-2012
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Quote:
Originally Posted by mbbs2010 View Post
it that the patient doesnt remember her memory defect.
I'm not sure if this is true. I think she does remember her memory defect, but she just doesn't seem to care about it because she's depressed. That's just a sign of a flat affect, not dementia.

I think it's a bit tricky here because you may use different interpretations of the word "unconcerned." Just because somebody is "unconcerned" about something doesn't mean that they don't even realize that it exists. Considering that the rest of the history is classic for pseudodementia, I think it's more likely that the patient isn't doing a good job of expressing the fact that she's aware of her memory deficit.
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