Distinguishing dementia from depression in the elderly: a case report

Abstract

Background: Memory problems in the elderly are a frequent reason for consultation in primary health care. This common complaint can have different causes with different outcomes, emphasizing the need for early diagnosis and timely management. The following case illustrates how family doctors can approach this problem and manage the diagnosis and treatment of memory problems. Case description: An 82-year old female patient widowed for 2 years and living with her daughter, who is her primary caregiver, came with her daughter to a medical appointment. The daughter complained that her mother was more apathetic, sadder, and sleepier in the last few months. She had been showing less interest in housework and did not want to leave the house as she formerly did. She had repetitive speech. Recently, she had experienced memory lapses and seemed to be slowing down. During the clinic visit, she told the doctor about her difficulty in paying for groceries, in recognizing acquaintances’ names, and in recognizing familiar objects. She had been disoriented at times, getting lost more than once in the street. The possible diagnoses considered were depressive disorder with cognitive impairment or dementia with depressive symptoms. The patient began treatment with sertraline, showing significant improvement in mood, performance and cognitive function, without signs of a cognitive deficit. Comment: Depression is not a natural consequence of old age. Many elderly people put physical complaints before feelings of sadness in primary care consultations. Pseudodementia may be potentially reversible with antidepressants and psychotherapy.