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Depressive Pseudodementia — MRCPsych Paper B MCQ

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ModerateOld Age PsychiatryDepressive PseudodementiaMRCPsych Paper B

A 75-year-old woman develops four months of forgetfulness and difficulty managing her correspondence during a severe depressive episode. During assessment she has marked psychomotor slowing, frequently answers “I don't know”, performs inconsistently across cognitive tasks and recalls more information when given cues. There is no cognitive fluctuation, visual hallucination, parkinsonism, focal neurological deficit, gait disorder or urinary incontinence. Following effective treatment of her depression, her everyday functioning and cognitive performance return to their premorbid baseline. Which diagnosis best accounts for the cognitive syndrome?

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Correct answer: D — Depression-related cognitive impairment

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

C is correct. The cognitive symptoms began with severe depression, were characterised by psychomotor slowing, variable performance and improved retrieval with cueing, and—most decisively—returned to the premorbid baseline when the depression remitted. This is depression-related cognitive impairment, historically termed depressive pseudodementia. NICE identifies depression as a potentially reversible cause of cognitive decline that should be investigated before dementia is diagnosed. Alzheimer's disease and vascular dementia would not be expected to resolve with depression treatment; vascular dementia would also require supporting vascular or focal neurological features. Dementia with Lewy bodies is unsupported without fluctuations, visual hallucinations or parkinsonism. Normal-pressure hydrocephalus is unlikely without gait impairment or urinary symptoms. Recurrence or progression should nevertheless prompt reassessment for neurodegenerative disease.

Reference: National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers (NG97), recommendations 1.2.6 and 1.2.9. 2018. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations