Pseudodementia(1)

Anonymousjpl123

This name came up at doctor visit with LO today. Geez, like I needed something else to worry about?? Moreover, they note that it could be a combination of dementia and Pseudodementia. The idea is that her depression/anxiety, and sharp worsening of symptoms after losing partner of 60 years could indicate a psychological component.

LO has a lot of other health issues on top of everything. Care is being coordinate between doctors and AL facility. 

I cannot believe how awful I feel: everything about Alzheimer’s and dementia to me feels so clear (memory score thing is 21/30, forgets who granddaughter is, mri shows atrophy and white matter) and not clear at all. 

I really want clarity, like a high quality gerontologist or specialist or something. I feel like we are going around and around, despite me taking her to highly regarded hospitals and centers.

Ed1937

Was this "doctor visit" with a neurologist who has dementia patients as a large part of his/her practice or someone else who specializes in dementia? Or was it with a PCP? I'm not a doctor of any kind, but I can understand how losing a LO could cause a decline in someone who has dementia. In my mind it doesn't make sense to have dementia and pseudo dementia. But I've been wrong more than once. Dementia exacerbated by losing a LO? Absolutely! But would you call that pseudo dementia?

Anonymousjpl123

Great question and thank you for taking the time to reply! It was a resident, a new hospital resident who has precisely three years of experience.  I’m trying to get her established with a solid primary care practice. This is my place but they are overbooked not really taking new patients. This person definitely doesn’t specialize in gerontology or neurology. That said, she refuses to go back to the original neurologist because “quote I did all the tests and they said nothing was wrong unquote.” 

Sometimes it feels useless to even go to doctors. She is not at the point where anything is so critical that she HAS to go: it’s just me trying to get her as an established patient in a new city.

I wish I never heard of pseudodementia because if this woman is faking it that would be truly horrific. Which I do recognize is not what that means lol.

She had one visit to a neurologist and an MRI last July that showed atrophy and white matter but I for sure am not a neurologist so no one who is qualified has told me anything because she refuses to go back to the neurologist.

So it’s a bunch of young (probably competent) residents reading an MRI. 

Iris L.

Pseudodementia usually refers to a major depression so profound that it appears exactly like dementia, but is reversible with treatment for depression.  Grief can be a subset of depression, who knows how long grief will last?  But the main distinction is that with Pseudodementia, there are no brain pathology changes, no atrophy.   

If there is a question of depression, the patient should receive aggressive antidepression treatment with medications and with talk therapy, for a minimum of four to six weeks.  Any nutritional deficits should be corrected.  Check all medications for cognitive side effects.  Read the Beers list.

If there is cardiac disease, adequate treatments may delay a progression of vascular dementia.

It is a good idea to have a baseline of cognitive function, because you would be looking for a significant decline over time.  Also, dementia mimics, of which there are many, need to be ruled out as soon as possible.

Iris L

Stuck in the middle

I agree with Iris.

It is important that pseudodementia is not faking.  It is a disease other than dementia that causes the same symptoms as dementia, such as memory loss and impaired judgment.  Grief and depression can do that, which is why it is a bad idea to make any major life changes for a year or so after a serious loss.

Anonymousjpl123

Iris thank you! Your calm perspective really helped. It’s hard because I can get so angry at how much time my LO (mother) is taking out of every day of my life I forget that the issue at hand is what is causing very significant cognition/memory impairment issues. If that is the train if thought to rule out they are doing everything right, because she is going back in 6 weeks, got full bloodwork again today,  and is taking prescribed supplements (since first moving here). 

In the end, this is the best thing for her. I may not get quick answers the way I want.

Stuck, you are so right: that is an important distinction. Not faking. In the end I am going to be this persons caretaker so it is probably just as well we made the move. I think the biggest problem is that my mom had a lot of mental health issues before my dad died so there isn’t a great baseline for me to gauge things. 

 Wherever this journey takes us is where I’ll go. I doubt she has Pseudodementia because there are brain changes: I think we just need to get the right doctors, ultimately have a neurologist follow up on the mri, and keep making sure she is getting care. I guess I’ll find out more each day. Thank you all for keeping me sane through this. 

Iris L.

Anonymous, you are doing the right thing, to ask questions.  Dementia is unlike other diseases because the PWD (person with dementia) often appears normal in some ways, at the same time has odd behaviors or bad judgement.  In fact, often bad judgement appears before significant memory loss.  PWDs develop difficulties in speech, both in talking and/or in comprehending.  Caregiving for a PWD is very rough, because you will have to learn everything new and differently from other diseases.  Caregiving a PWD does take up a lot of time, and the time commitment grows as the person declines.  PWDs also exhibit anosognosia, meaning they are unaware of their changes or that they need help.  They actively resist help.  This is anosognosia, not denial.  It can be discouraging for the caregiver.  The best thing is to read a lot and learn what you can expect.  Not every complication will occur, but at least you will be prepared.  Read a lot of threads and post a lot.  The members here are knowledgeable and are willing to share.

Do you live with her?  Do not rely on her to take her meds correctly.  It is a good idea to discreetly observe to see how she does.  Anosognosia makes the PWD believe she is fine, and she might either refuse to take medication, or say she has taken it when she has not.  This isn't lying, they begin to not know what they are doing.

Iris

Anonymousjpl123

Hi Iris, again, so so many thanks for your patience and reply. Thankfully, she is in an AL/MC facility and does not manage her meds. The facility quickly put her on medication management the first month thank god. 

Her dementia/cognitive decline is so obvious to everyone around her in her daily life. But doctors have not given her any kind of diagnosis. I don’t know why none of the primary care doctors have mentioned her MRI results.

Maybe it’s because she has a lot of other medical issues (diabetes, etc.) that need attention.

Maybe it’s because the neurologist needs to do that follow up, and she won’t go. 

They have done the vitamin b12 testing etc.  Also, she definitely has Anasognosia because although she is aware of the mistakes she makes, she’s adamant there is nothing wrong with her memory.  

My only hope is that by establishing her as a patient at a primary care practice & neurologist at the same medical center, which is also  affiliated with her AL, at some point, everyone will put the pieces together.

My frustration is that she  handles less and less on the daily (example: now, she not only can’t use a credit card, but can’t handle Amazon without ordering 25 of the same thing. We tried gift cards but the cache on her phone kept finding her old card). Her life is getting smaller, her cognition declining, which is why I’m frustrated by no clear diagnosis.

She refuses to go to counseling - which her GP offered. The only thing she’ll tolerate is the primary care doctor who has very little knowledge of elder care or alz/dementia. So here I am. I guess I just have to suck it up and be grateful she has any care at all. The year before she moved here was a nightmare so at least this is not that.

It’s like Ed said. I was taken aback by seeing “dementia, Pseudodementia, other” listed with everything else in the Memory Issues section of her Mychart novel. I feel a diagnosis would give me relief. I guess we have to wait and see. Thanks again everyone for listening. This board has been my lifeline since this journey began.

Iris L.

Anonymous, there is a lot of "nebulosity" (I created a word) regarding dementia.  Some doctors refuse to be definitive because the only true diagnosis is made by autopsy or brain biopsy, which is unlikely.  The diagnosis is an educated guess.  But, after everything treatable has been ruled out, you go with dementia.  This is because the prognosis is the same for all, terminal.  There are different demrntias for which medication choice may be different.  And the course nay be different.  But the endings are the same.

I suggest you read a lot of threads and the online reading material, plus alz.org.  Then you will know as much as many professionals regarding dementia caregiving.  You will be able to be more precise in your questioning.  I also suggest that you ask your questions of the members, because they do know quite a lot and have had all experiences.  If there is something they don't know, they will find out.  Sharing is the only way for us, because in actuality, the public's understanding of dementia is sorely limited.

Iris