Pseudodementia in elderly with depression: clinical and psychometric features for differential diagnosis

Abstract

Cognitive impairment in the elderly can be caused by both neurodegenerative and mental disorders, especially depression. In some cases, depressive states mimic dementia, — a condition known as pseudo-dementia. Identifying clinical and psychometric markers that help distinguish these conditions is of high practical importance. Scientific articles from the PubMed and Google Scholar databases published during 2021–2025 were analyzed, focusing on clinical manifestations, neuropsychological testing, and the course of illness in elderly patients with depression and/or dementia. It was found that patients with pseudo-dementia more often report active complaints about cognitive difficulties, while patients with dementia tend to deny or ignore their symptoms. In neuropsychological tests, the pseudo-dementia group retains some learning ability, and impairments in attention and memory are moderate and inconsistent. Pseudo-dementia is characterized by symptom reversibility with appropriate treatment, whereas cognitive decline in dementia is progressive. Longitudinal studies show that 62% of patients with pseudo-dementia experience remission, and 38% transform into true dementia, which emphasizes the need for dynamic observation. Pseudo-dementia requires a careful diagnostic approach. The key differences are the nature of complaints, emotional background, results of psychometric tests (MMSE, MoCA, learning tests) and dynamics in response to therapy. Differential diagnostics should be based on a comprehensive evaluation of cognitive, affective and functional indicators, with mandatory follow-up.