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Suggest Treatment For Depressive Dementia
Question:
Hello,
I am writing to you regarding potential conditions which may explain symptoms that I have observed over these 2 years.
She is a 42 year old woman who was born in the Philippines. She moved to NYC in 2000. English is her second language but she has very strong vocabulary skills.
During the time that I have known her, I have considered the following potential conditions:
- PTSD
- Mild Cognitive Impairment
- Adult ADHD
- Low grade depression
The symptoms that I have observed are:
- Nearly no recollection of childhood memories
> When I ask her a question about her childhood, she says, "I have to ask my sister."
- Social Anxiety
> She did not start dating until she was 37 years out.
> I have taken her out to meet colleagues. Quite often, she did not say one word the whole night.
> She has become much more outgoing interacting with my family, though.
- Short Attention span. More comprehension.
> Not so much lately, but we used to watch movies together and during a scene in the middle of the movie, she would point to the main character and ask what part that person plays.
> Because we have a communication difficulties, I have started to ask her to rephrase what I've said to ensure the intended message was received correctly, for the most part.
> My anecdotal evidence seems to suggest that:
>> She remembers 35% of content delivered in a two minute time span.
>> Her comprehension of the content delivered is around 20%.
- Mildly inappropriate responses to situations.
> As an example, I might be speaking of something very stressful for to me. If I try to put on a "brave" face with a little smile, she will react as if I was delivering good news.
- Flat Effect
> She rarely demonstrates an emotional response to situations that normally elicits emotions.
> it seems like she has a complete of empathy for me. But if I say anything about how that affects me, she is easily brought to tears. Not for me but because it affects her low self-esteem.
She has seen a Psychiatrist and a Neurologist:
Psychiatrist:
- The Psychiatrist diagnosed her as having some form of Depression and some form of AHD, without the hyperactivity.
> The Psychiatrist prescribed Prozac and Adderall for her. (She's been on this combination of medication.)
> I thought the choice of Prozac was a little odd. I think that SNRIs alleviate symptoms of Depression than SSRIs do.
> After she started taking the Adderall, I noticed an improvement in her focus. But by 8:00 PM, her focus became poor again.
>> That's when I found out that the doctor prescribed Adderall Quick Release, instead of Adderall Extended Release.
>> I asked her to ask her doctor to switch the Quick Release to Extended Release. However, my girlfriend only started taking the Extended Release yesterday.
Neurologist:
- The Neurologist thinks she has some type of Cognitive Impairment but he doesn't think it's degenerative. He said that it was most likely "chemical".
- She did not ask him what he meant by "chemical" so I contacted him to ask if he was speaking about neurotransmitters, specifically Norepinephrine. It's the only one that I know that could be associated with some of these types of symptoms.
- The Neurologist indicated he was speaking about Norepinephrine AND Serotonin.
- I know that SSRIs have a secondary affect of the levels of Norepinephrine but, to me, it was an additional indication that switching to an SNRI was warranted. However, the Psychiatrist wants to stick to the current "cocktail".
I am starting to find it more and more difficult to believe that she has been diagnosed as having three different disorders, instead of one disorder which could explain all of her observable symptoms.
For full disclosure, over ten years ago I was diagnosed has having Bipolar Type 1 Disorder. I am still in the recovery phase from a Panic Disorder episode that started in March of this year.
I am very concerned that when I asked her how she thinks she has been doing the last two months, she said she felt she was doing much better. However, I feel as if things have gotten far, far worse.
I don't think she is receive the proper diagnosis or treatment plans but I am not a doctor and I do not know where to turn next.
She asked me to call my Father's Neurologist at XXXXXXX Universities Neurological Institute for Aging, Memory and Behavioral Disorders.
The stress that I've been experiencing trying to live together has been creating a lot of mood lability for me, which I have not been able to manage effectively these last three months. But, today, instead of feeling stressed, angry and frustrated, I just became completely anxious that she might have a significant degenerative disorder.
Any feedback you could provide would be truly appreciated.
Sincerely,
XXXX
PS. I've try to describe things to which I am best abled. So please forgive some outright misstatements I may have made in this note.
Hello,
I am writing to you regarding potential conditions which may explain symptoms that I have observed over these 2 years.
She is a 42 year old woman who was born in the Philippines. She moved to NYC in 2000. English is her second language but she has very strong vocabulary skills.
During the time that I have known her, I have considered the following potential conditions:
- PTSD
- Mild Cognitive Impairment
- Adult ADHD
- Low grade depression
The symptoms that I have observed are:
- Nearly no recollection of childhood memories
> When I ask her a question about her childhood, she says, "I have to ask my sister."
- Social Anxiety
> She did not start dating until she was 37 years out.
> I have taken her out to meet colleagues. Quite often, she did not say one word the whole night.
> She has become much more outgoing interacting with my family, though.
- Short Attention span. More comprehension.
> Not so much lately, but we used to watch movies together and during a scene in the middle of the movie, she would point to the main character and ask what part that person plays.
> Because we have a communication difficulties, I have started to ask her to rephrase what I've said to ensure the intended message was received correctly, for the most part.
> My anecdotal evidence seems to suggest that:
>> She remembers 35% of content delivered in a two minute time span.
>> Her comprehension of the content delivered is around 20%.
- Mildly inappropriate responses to situations.
> As an example, I might be speaking of something very stressful for to me. If I try to put on a "brave" face with a little smile, she will react as if I was delivering good news.
- Flat Effect
> She rarely demonstrates an emotional response to situations that normally elicits emotions.
> it seems like she has a complete of empathy for me. But if I say anything about how that affects me, she is easily brought to tears. Not for me but because it affects her low self-esteem.
She has seen a Psychiatrist and a Neurologist:
Psychiatrist:
- The Psychiatrist diagnosed her as having some form of Depression and some form of AHD, without the hyperactivity.
> The Psychiatrist prescribed Prozac and Adderall for her. (She's been on this combination of medication.)
> I thought the choice of Prozac was a little odd. I think that SNRIs alleviate symptoms of Depression than SSRIs do.
> After she started taking the Adderall, I noticed an improvement in her focus. But by 8:00 PM, her focus became poor again.
>> That's when I found out that the doctor prescribed Adderall Quick Release, instead of Adderall Extended Release.
>> I asked her to ask her doctor to switch the Quick Release to Extended Release. However, my girlfriend only started taking the Extended Release yesterday.
Neurologist:
- The Neurologist thinks she has some type of Cognitive Impairment but he doesn't think it's degenerative. He said that it was most likely "chemical".
- She did not ask him what he meant by "chemical" so I contacted him to ask if he was speaking about neurotransmitters, specifically Norepinephrine. It's the only one that I know that could be associated with some of these types of symptoms.
- The Neurologist indicated he was speaking about Norepinephrine AND Serotonin.
- I know that SSRIs have a secondary affect of the levels of Norepinephrine but, to me, it was an additional indication that switching to an SNRI was warranted. However, the Psychiatrist wants to stick to the current "cocktail".
I am starting to find it more and more difficult to believe that she has been diagnosed as having three different disorders, instead of one disorder which could explain all of her observable symptoms.
For full disclosure, over ten years ago I was diagnosed has having Bipolar Type 1 Disorder. I am still in the recovery phase from a Panic Disorder episode that started in March of this year.
I am very concerned that when I asked her how she thinks she has been doing the last two months, she said she felt she was doing much better. However, I feel as if things have gotten far, far worse.
I don't think she is receive the proper diagnosis or treatment plans but I am not a doctor and I do not know where to turn next.
She asked me to call my Father's Neurologist at XXXXXXX Universities Neurological Institute for Aging, Memory and Behavioral Disorders.
The stress that I've been experiencing trying to live together has been creating a lot of mood lability for me, which I have not been able to manage effectively these last three months. But, today, instead of feeling stressed, angry and frustrated, I just became completely anxious that she might have a significant degenerative disorder.
Any feedback you could provide would be truly appreciated.
Sincerely,
XXXX
PS. I've try to describe things to which I am best abled. So please forgive some outright misstatements I may have made in this note.
Brief Answer:
Depressive dementia
Detailed Answer:
Hello thanks for asking from Health Care Magic
I have read your query and I can understand your problem.
I will go to details of her symptoms one by one and will try to explain the symptoms.
She is a 42 years female which is having symptoms like
No recollection of childhood memories and when asked she says that I have to ask my sister. It appears that she is not able to recollect the memories either due to denial or due to retrospective falsification. It is common in depressive patients. The loss of memory can't be justified by cognitive impairment of neurological lesion because in Cognitive impairment usually immediate and recent memory is lost. Memory to past remains intact. In severely depressed patients depressive pseudodemenita may cause loss of memory because of lack of focus and concentration
Her other symptom is social anxiety and poor social interaction. This can be explained by depression also. Due to lack of confidence individuals make negative self image which could be the reason of her dating late in life.
Short attention span: especially during watching movie like forgetting characters. In severe depression individuals fail to focus and they sometimes loose the continuity of normal thought process which could become evident like they are not listening us. She is not retaining the content delivered this could be due to lack of concentration and focus. I don't think this can represent cognitive decline considering her other symptoms.
She has flat affect and she behaves inappropriate in certain situations and this is also pointing us towards depression. Apathy is common in severe depression.
Now coming to discussion-
A psychiatrist has labeled her with depression and some form of ADD. As per my opinion from the information you have provided we can put her into depression but for ADD we need more detailed evaluation. There are various theories of depression and biochemical theory states that depression occurs due to deficient nor adrenaline and serotonin transmission. This is true that SNRIs help in restoring the neurotransmission of both chemicals but if we consider efficacy in depression then SSRIs are better than SNRIs. SNRIs especially duloxetine causes sedation and this will worsen the symptoms of drowsiness in her.
Prozac is fluoxetine and the drug help in maintaining day time awakening which can be beneficial in her symptoms of inattention, apart from acting as good anti-depressant.
Adderall will help in maintain day time wakefulness and should improve her symptoms.
So as per my opinion Prozac and Adderall is good combination for her.
Now coming from neurological side-
Yes SSRIs will increase the NE action by indirect action and this will help to improve alertness. SNRIs have more NE action and they are more useful in pain conditions rather than in severe depressive conditions.
I don't think she should be labeled as cognitive impairment because chemical cognitive impairment is nothing but underlying pseudo dementia.
Now to sum up: as she is also showing response to her current medications so as per my opinion medicines should not be changed. As per me considering the symptoms you have written she has been diagnosed accurately.
I hope it solved your doubts, still if you have more doubts you can ask again. I have used a little medical term in my answer but if you want more details you can ask again.
Thanks
Dr. Seikhoo Bishnoi,
Consultant Psychiatrist
Depressive dementia
Detailed Answer:
Hello thanks for asking from Health Care Magic
I have read your query and I can understand your problem.
I will go to details of her symptoms one by one and will try to explain the symptoms.
She is a 42 years female which is having symptoms like
No recollection of childhood memories and when asked she says that I have to ask my sister. It appears that she is not able to recollect the memories either due to denial or due to retrospective falsification. It is common in depressive patients. The loss of memory can't be justified by cognitive impairment of neurological lesion because in Cognitive impairment usually immediate and recent memory is lost. Memory to past remains intact. In severely depressed patients depressive pseudodemenita may cause loss of memory because of lack of focus and concentration
Her other symptom is social anxiety and poor social interaction. This can be explained by depression also. Due to lack of confidence individuals make negative self image which could be the reason of her dating late in life.
Short attention span: especially during watching movie like forgetting characters. In severe depression individuals fail to focus and they sometimes loose the continuity of normal thought process which could become evident like they are not listening us. She is not retaining the content delivered this could be due to lack of concentration and focus. I don't think this can represent cognitive decline considering her other symptoms.
She has flat affect and she behaves inappropriate in certain situations and this is also pointing us towards depression. Apathy is common in severe depression.
Now coming to discussion-
A psychiatrist has labeled her with depression and some form of ADD. As per my opinion from the information you have provided we can put her into depression but for ADD we need more detailed evaluation. There are various theories of depression and biochemical theory states that depression occurs due to deficient nor adrenaline and serotonin transmission. This is true that SNRIs help in restoring the neurotransmission of both chemicals but if we consider efficacy in depression then SSRIs are better than SNRIs. SNRIs especially duloxetine causes sedation and this will worsen the symptoms of drowsiness in her.
Prozac is fluoxetine and the drug help in maintaining day time awakening which can be beneficial in her symptoms of inattention, apart from acting as good anti-depressant.
Adderall will help in maintain day time wakefulness and should improve her symptoms.
So as per my opinion Prozac and Adderall is good combination for her.
Now coming from neurological side-
Yes SSRIs will increase the NE action by indirect action and this will help to improve alertness. SNRIs have more NE action and they are more useful in pain conditions rather than in severe depressive conditions.
I don't think she should be labeled as cognitive impairment because chemical cognitive impairment is nothing but underlying pseudo dementia.
Now to sum up: as she is also showing response to her current medications so as per my opinion medicines should not be changed. As per me considering the symptoms you have written she has been diagnosed accurately.
I hope it solved your doubts, still if you have more doubts you can ask again. I have used a little medical term in my answer but if you want more details you can ask again.
Thanks
Dr. Seikhoo Bishnoi,
Consultant Psychiatrist
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hi.
Thank you so much for your responses and explanations.
I was wondering if you could tell me the difference between dementia and depressive dementia?
How should this condition be treated?
What do we need to do to confirm this diagnosis?
Thank you so much,
XXXX
Thank you so much for your responses and explanations.
I was wondering if you could tell me the difference between dementia and depressive dementia?
How should this condition be treated?
What do we need to do to confirm this diagnosis?
Thank you so much,
XXXX
Brief Answer:
DEMENTIA
Detailed Answer:
Hello thanks for asking again
Dementia is basically a neuropsychiatric condition in which degeneration of neurones occur which result in progressive decline in cognitive functions. Common dementias are Alzheimer's dementia, Vascular dementia (due to brain haemorrhages), dementia due to Parkinson's disease, senile dementia etc. Usual dementias like Alzheimer's are seen after about 60 years of age. The symptoms are progressive loss of memory, naming difficulties, immediate and recent memory is lost mainly with surprisingly intact remote memory (except in late stage).
Depressive dementia is also called as Pseudo-dementia. Basic psychopathology behind depressive dementia is loss of concentration and focus. Individuals start showing cognitive decline mainly in form of loss of memory. Other cognitive functions remain normal in most of individuals. When interviewed the patient of classical dementia will tries to answer memory related question or instead he may give false answer. In depressive pseudo-dementia individuals will not answer at all, they will refuse to answer and appear indifferent.
Dementia loss is progressive and gradual decline is seen while in pseudo-dementia onset is acute and abrupt.
Depressive demential improves by improvement of symptoms of depression. So treatment of depression is the treatment of this dementia.
To confirm diagnosis consult a psychiatrist for tests related to dementia like XXXXXXX mental status examination (MMSE).
Thanks
DEMENTIA
Detailed Answer:
Hello thanks for asking again
Dementia is basically a neuropsychiatric condition in which degeneration of neurones occur which result in progressive decline in cognitive functions. Common dementias are Alzheimer's dementia, Vascular dementia (due to brain haemorrhages), dementia due to Parkinson's disease, senile dementia etc. Usual dementias like Alzheimer's are seen after about 60 years of age. The symptoms are progressive loss of memory, naming difficulties, immediate and recent memory is lost mainly with surprisingly intact remote memory (except in late stage).
Depressive dementia is also called as Pseudo-dementia. Basic psychopathology behind depressive dementia is loss of concentration and focus. Individuals start showing cognitive decline mainly in form of loss of memory. Other cognitive functions remain normal in most of individuals. When interviewed the patient of classical dementia will tries to answer memory related question or instead he may give false answer. In depressive pseudo-dementia individuals will not answer at all, they will refuse to answer and appear indifferent.
Dementia loss is progressive and gradual decline is seen while in pseudo-dementia onset is acute and abrupt.
Depressive demential improves by improvement of symptoms of depression. So treatment of depression is the treatment of this dementia.
To confirm diagnosis consult a psychiatrist for tests related to dementia like XXXXXXX mental status examination (MMSE).
Thanks
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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