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Pseudodementia vs Dementia — MRCPsych Paper B MCQ

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HardOld Age PsychiatryPseudodementia vs DementiaMRCPsych Paper B

A 73-year-old woman with a severe depressive episode scores 20/30 on the MMSE. It remains unclear whether her cognitive impairment is predominantly depression-associated or reflects an underlying neurodegenerative dementia. Which additional clinical pattern would most strongly support depression-associated cognitive impairment as the main cause?

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Correct answer: C — Subacute decline with marked distress, variable performance and frequent “don't know” responses

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · E = shown as D · A = shown as E

B is the pattern most suggestive of depression-associated cognitive impairment, historically termed depressive “pseudodementia”. A relatively subacute onset linked to depression, prominent distress about cognitive failures, variable performance and frequent “don't know” responses favour impaired attention, effort and retrieval rather than a primary progressive storage disorder. By contrast, collateral-confirmed gradual functional decline (A), progression despite mood remission (C), rapid forgetting with impaired recognition (D), and cortical visuospatial deficits with topographical disorientation (E) increase concern for neurodegenerative dementia. Subjective complaints alone are not diagnostic, because depression and dementia can coexist and cognitive deficits may persist after mood improves. NICE therefore recommends investigating depression and using specialist or neuropsychological assessment when the cause remains uncertain.

Reference: Teixeira AL et al. Cognitive Deficits in Late-Life Depression: From Symptoms and Assessment to Therapeutics. Focus. 2025;23(2):183–194. https://pubmed.ncbi.nlm.nih.gov/40235602/