When Depression Looks Like Dementia

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Daniel G. Amen, MD

I first met Margaret when she was 68 years old. She lived alone, and her family was worried because she appeared to have symptoms of serious dementia. She was ragged and unkempt, she often forgot the names of her own children, she frequently got lost and she had just had her driver’s license revoked after having four minor accidents in a six-month period. When she nearly burned the house down by leaving a stove burner on, her family finally admitted her to the psychiatric hospital where I worked. Some members of Margaret’s family had had enough and were ready to put her into a supervised living situation.

It seemed that Margaret was suffering from dementia. I ordered a SPECT study to see what was happening in her brain. The results showed full activity in her parietal and temporal lobes. If she had Alzheimer’s disease, there should have been evidence of decreased blood flow in those areas. Instead, the only abnormal activity shown on Margaret’s SPECT was in the deep limbic system at the center of the brain, where the activity was increased. Often, this is a finding in people suffering from depression.

Sometimes in the elderly, it can be difficult to distinguish between Alzheimer’s and depression because the symptoms can be similar. When depression “masquerades” as dementia, we call it pseudodementia. A person suffering from pseudodementia may appear demented, yet not be at all. See a comparison of SPECT images here.

Depression & Dementia Are Two VERY Different Treatment Paths

The diagnosis makes a critical difference in a person’s life. Depression is highly treatable; dementia is a much tougher go.

The diagnosis of dementia would lead to prescribing to the family a set of coping strategies and possibly new medications to the patient, whereas a diagnosis of some form of depression would lead to prescribing an aggressive treatment of supplements or antidepressant medication, along with psychotherapy and exercise. You can see how the distinction would color the entire picture for not only the individual but his or her family. It changes relationships. It determines whether a person is able to live independently.

The Importance of Brain Imaging

In my experience, brain imaging is a critical tool in accurate diagnosis. Before brain imaging, most psychiatrists never looked at the organ they treated. They referred to a list of symptoms and did their best to accurately diagnose a patient. I have often thought of it as throwing darts in the dark. Because of the extreme difference in treatment directions – inaction, where the condition is guaranteed to persist versus action that can be very effective in restoring the quality of life – pseudodementia is a condition that is especially impacted by the lack of “sight” into the functionality of the brain.

A Hopeful Outcome

The results of Margaret’s SPECT study convinced me that she should try the antidepressant Wellbutrin (buproppion). After three weeks, she was talkative, well groomed and eager to socialize with other patients. After a month in the hospital, she was released to go home. Six months later I repeated her SPECT study and it was completely normal. She remained markedly improved. So much so that I felt comfortable writing a letter to the DMV, and it gave her back her license!

Dementia-like symptoms? Seek help.

People over the age of 65 are at highest risk for pseudodementia. If you or a loved one are experiencing symptoms of confusion, forgetfulness, poor concentration, slower speech and function, apathy and decreased energy, consider an evaluation for pseudodementia. At the Amen Clinics, we use SPECT imaging to see blood flow and brain function, which goes a long way to indicate the true nature of the condition.



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