Simple Test for Pseudodementia of Depression
Courtesy of Dr. Katherine Day

Many people, particularly people in their sixties and seventies, come into the psychologist's office with complaints about memory loss. If the therapist probes for the concerns that underlie the complaint, he or she will often find these patients are fearful they may be manifesting signs of "Alzheimers's." While there is no simple way to diagnose Alzheimer's, there are some general guidelines that can help distinguish Dementia of the Alzheimer's type (DAT) from the pseudodementia of depression, which definitely is a reversible condition.

First, get a careful history from the patient, as well as from whomever came in with him or her. The patient who arrives alone, having noticed the problem independently, is far less likely to have DAT than a patient brought in by a family member. A patient who makes light of the problem, showing little or no subjective distress, is a more likely DAT candidate.

Second, if the patient's history shows recent personal losses, carefully assess for depression. Inquire about sleep patterns (remember that deep sleep normally decreases with advancing age), sexual patterns, appetite, and enjoyment of friends and activities. Also, assess other cognitive skills, such as decision making, planning and follow-through, and concentration -- things very likely to be effected by depression, but less likely to be early signs of DAT.

Finally, here is a simple test I first heard about at a conference years ago. I no longer recall the name of the nurse who introduced the idea, but, over the years, I have refined it quite a bit. The concept is simple: In DAT, the associations break down, as well as simple recall power; in pseudodementia of depression, they do not.

Begin by reciting a list of ten items to the patient, and then ask them to recall as many as possible. I use the following list:
1. daisy        6. New York
2. shirt        7. brown
3. Oldsmobile        8. triangle
4. hammer        9. sofa
5. cow        10. nickel

Give them two minutes to remember all they can. It is not important how many the patient remembers, even if he or she cannot recall a single one!

Then say, "I'll give you a hint. One of them is a coin." Start with the last one in the sequence they missed and give the category to which the stimulus word belongs. (e.g. furniture; shape; color; city; animal; tool; automobile; article of clothing; flower.) If the hints help them to at least double their score, or gets them to seven, it greatly raises the index of suspicion that the problem is pseudodementia of depression, not DAT. You can then reassure the patient as follows: "There is no way to be absolutely certain that you won't get Alzheimer's Disease, but the pattern of forgetfulness you are showing at this time is not consistent with it. It is consistent with what is called the pseudodementia of depression. That we can reverse." Then introduce the idea that depression affects all the individual systems--physical, cognitive and emotional--and talk about treatment for depression.