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Copyright (c) 2025 Khalid Mohammed S. Alshwikan, Latifah Moner Albogami, Zainab Ibrahim Saigh, Nowayer Saad Sayed Alhaydal, Tahani Ebrahim Ali Mabooj, Ghada Ebrahim Ali Mabouj, Ghina Ibrahim Ali Mabuj, Maram Hussin Mohammed Banajiah
This work is licensed under a Creative Commons Attribution 4.0 International License.
Interdisciplinary Clinical Assessment and Management of Depressive Cognitive Disorders: Integrating Social Work, Nursing Practice, and Clinical Pathology in Patient-Centered Care
Corresponding Author(s) : Khalid Mohammed S. Alshwikan
Saudi Journal of Medicine and Public Health, Vol. 2 No. 2 (2025)
Abstract
Background: Depressive cognitive disorder—historically termed pseudodementia—is a reversible or partially reversible cognitive impairment arising from underlying depressive or neuropsychiatric conditions. Its presentation often overlaps with neurodegenerative dementias, complicating diagnosis and delaying appropriate management.
Aim: This review aims to synthesize current evidence on the etiology, epidemiology, pathophysiology, clinical evaluation, and management of depressive cognitive disorders to support early recognition and improve interdisciplinary care.
Methods: A comprehensive analysis of contemporary clinical literature was performed, addressing neurochemical, structural, endocrine, genetic, and psychosocial contributors to depressive cognitive decline. The article integrates findings from neuropsychological testing frameworks, neuroimaging studies, and validated depression rating scales commonly used in older adults.
Results: Evidence indicates that depressive cognitive disorders stem from multifactorial mechanisms, including serotonergic dysfunction, hippocampal and amygdala abnormalities, HPA axis hyperactivity, circadian disruption, maladaptive cognitive patterns, and psychosocial stress. Prevalence is high among older adults, with cognitive impairment present in up to 94% of patients during depressive episodes. Despite reversibility in many cases, up to 70% of individuals with depression related cognitive impairment may progress to dementia over time. Effective management requires SSRIs or SNRIs as first line therapies, complemented by ECT, psychotherapy, caregiver support, and lifestyle interventions.
Conclusion: Depressive cognitive disorder is a complex condition requiring multidimensional assessment and interprofessional management. Early identification and targeted treatment can improve cognitive and functional outcomes, though long term prognosis varies.
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- Kiloh LG. Pseudo-dementia. Acta Psychiatr Scand. 1961;37(4):336-51.
- Buccianelli B, Marazziti D, Arone A, Palermo S, Simoncini M, Carbone MG, Massoni L, Violi M, Dell'Osso L. Depression and Pseudodementia: Decoding the Intricate Bonds in an Italian Outpatient Setting. Brain Sci. 2023 Aug 13;13(8)
- Elefante C, Brancati GE, Acierno D, Pistolesi G, Ricciardulli S, Weiss F, Romeo F, Lattanzi L, Maremmani I, Perugi G. Pseudodementia in Patients with Unipolar and Bipolar Disorders: A Case Series and Literature Review. J Clin Med. 2024 Mar 19;13(6)
- Perini G, Cotta Ramusino M, Sinforiani E, Bernini S, Petrachi R, Costa A. Cognitive impairment in depression: recent advances and novel treatments. Neuropsychiatr Dis Treat. 2019;15:1249-1258.
- Hammar Å, Ronold EH, Rekkedal GÅ. Cognitive Impairment and Neurocognitive Profiles in Major Depression-A Clinical Perspective. Front Psychiatry. 2022;13:764374.
- Heser K, Bleckwenn M, Wiese B, Mamone S, Riedel-Heller SG, Stein J, Lühmann D, Posselt T, Fuchs A, Pentzek M, Weyerer S, Werle J, Weeg D, Bickel H, Brettschneider C, König HH, Maier W, Scherer M, Wagner M., AgeCoDe Study Group. Late-Life Depressive Symptoms and Lifetime History of Major Depression: Cognitive Deficits are Largely Due to Incipient Dementia rather than Depression. J Alzheimers Dis. 2016 Aug 01;54(1):185-99.
- Richly P, Abdulhamid P, Bustin J. [Depressive pseudodementia. Differential diagnosis or meeting point?]. Vertex. 2012 Nov-Dec;23(106):421-7.
- Banga A, Gyurmey T, Matuskey D, Connor DF, Kaplan RF, Steffens DC. Late-life onset bipolar disorder presenting as a case of pseudo-dementia: a case discussion and review of literature. Yale J Biol Med. 2013 Jun;86(2):235-44.
- Niizato K, Koto T. [Manic state and manic pseudodementia]. Nihon Rinsho. 2013 Oct;71(10):1781-6.
- Kobayashi T, Kato S. Depression-dementia medius: between depression and the manifestation of dementia symptoms. Psychogeriatrics. 2011 Sep;11(3):177-82.
- Afzal A, Ahmad S, Agha F, Batool Z, Tabassum S, Liaquat L, Sadir S, Nawaz A, Haider S. Administration of 5-HT-1B agonist ameliorates pseudodementia induced by depression in rats. Pak J Pharm Sci. 2018 Sep;31(5(Supplementary)):2179-2184.
- Paula JJ, Miranda DM, Nicolato R, Moraes EN, Bicalho MA, Malloy-Diniz LF. Verbal learning on depressive pseudodementia: accentuate impairment of free recall, moderate on learning processes, and spared short-term and recognition memory. Arq Neuropsiquiatr. 2013 Sep;71(9A):596-9.
- Bieniek KF, van Blitterswijk M, Baker MC, Petrucelli L, Rademakers R, Dickson DW. Expanded C9ORF72 hexanucleotide repeat in depressive pseudodementia. JAMA Neurol. 2014 Jun;71(6):775-81.
- Vinet-Couchevellou M, Sauvagnat F. [Pseudodementia, what are we talking about? Part II: From Stertz to Alzheimer: A psychogenic disease after trauma]. Encephale. 2015 Jun;41 Suppl 1:S37-43.
- Sekhon S, Patel J, Sapra A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 26, 2023. Late-Life Depression.
- Kang H, Zhao F, You L, Giorgetta C, D V, Sarkhel S, Prakash R. Pseudo-dementia: A neuropsychological review. Ann Indian Acad Neurol. 2014 Apr;17(2):147-54.
- Tripathi R, Mehrotra S. Pseudo-dementia: A neuropsychological review. Ann Indian Acad Neurol. 2015 Jan-Mar;18(1):123-4.
- Sahin S, Okluoglu Önal T, Cinar N, Bozdemir M, Çubuk R, Karsidag S. Distinguishing Depressive Pseudodementia from Alzheimer Disease: A Comparative Study of Hippocampal Volumetry and Cognitive Tests. Dement Geriatr Cogn Dis Extra. 2017 May-Aug;7(2):230-239.
- Vaish AK, Jain N, Gutch M, Yadav H. Pseudodementia due to intracranial tuberculomas: an unusual presentation. BMJ Case Rep. 2011 Dec 13;2011
- Towsley G, Neradilek MB, Snow AL, Ersek M. Evaluating the Cornell Scale for Depression in Dementia as a proxy measure in nursing home residents with and without dementia. Aging Ment Health. 2012;16(7):892-901.
- Laver K, Dyer S, Whitehead C, Clemson L, Crotty M. Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews. BMJ Open. 2016 Apr 27;6(4):e010767.
- Rapinesi C, Serata D, Del Casale A, Kotzalidis GD, Mazzarini L, Fensore C, Carbonetti P, Scatena P, Capezzuto S, Moscati FM, Brugnoli R, Tatarelli R, Girardi P. Depressive pseudodementia in the elderly: effectiveness of electroconvulsive therapy. Int J Geriatr Psychiatry. 2013 Apr;28(4):435-8.
- Tobe E. Pseudodementia caused by severe depression. BMJ Case Rep. 2012 Dec 14;2012
- Gale SA, Acar D, Daffner KR. Dementia. Am J Med. 2018 Oct;131(10):1161-1169.
References
Kiloh LG. Pseudo-dementia. Acta Psychiatr Scand. 1961;37(4):336-51.
Buccianelli B, Marazziti D, Arone A, Palermo S, Simoncini M, Carbone MG, Massoni L, Violi M, Dell'Osso L. Depression and Pseudodementia: Decoding the Intricate Bonds in an Italian Outpatient Setting. Brain Sci. 2023 Aug 13;13(8)
Elefante C, Brancati GE, Acierno D, Pistolesi G, Ricciardulli S, Weiss F, Romeo F, Lattanzi L, Maremmani I, Perugi G. Pseudodementia in Patients with Unipolar and Bipolar Disorders: A Case Series and Literature Review. J Clin Med. 2024 Mar 19;13(6)
Perini G, Cotta Ramusino M, Sinforiani E, Bernini S, Petrachi R, Costa A. Cognitive impairment in depression: recent advances and novel treatments. Neuropsychiatr Dis Treat. 2019;15:1249-1258.
Hammar Å, Ronold EH, Rekkedal GÅ. Cognitive Impairment and Neurocognitive Profiles in Major Depression-A Clinical Perspective. Front Psychiatry. 2022;13:764374.
Heser K, Bleckwenn M, Wiese B, Mamone S, Riedel-Heller SG, Stein J, Lühmann D, Posselt T, Fuchs A, Pentzek M, Weyerer S, Werle J, Weeg D, Bickel H, Brettschneider C, König HH, Maier W, Scherer M, Wagner M., AgeCoDe Study Group. Late-Life Depressive Symptoms and Lifetime History of Major Depression: Cognitive Deficits are Largely Due to Incipient Dementia rather than Depression. J Alzheimers Dis. 2016 Aug 01;54(1):185-99.
Richly P, Abdulhamid P, Bustin J. [Depressive pseudodementia. Differential diagnosis or meeting point?]. Vertex. 2012 Nov-Dec;23(106):421-7.
Banga A, Gyurmey T, Matuskey D, Connor DF, Kaplan RF, Steffens DC. Late-life onset bipolar disorder presenting as a case of pseudo-dementia: a case discussion and review of literature. Yale J Biol Med. 2013 Jun;86(2):235-44.
Niizato K, Koto T. [Manic state and manic pseudodementia]. Nihon Rinsho. 2013 Oct;71(10):1781-6.
Kobayashi T, Kato S. Depression-dementia medius: between depression and the manifestation of dementia symptoms. Psychogeriatrics. 2011 Sep;11(3):177-82.
Afzal A, Ahmad S, Agha F, Batool Z, Tabassum S, Liaquat L, Sadir S, Nawaz A, Haider S. Administration of 5-HT-1B agonist ameliorates pseudodementia induced by depression in rats. Pak J Pharm Sci. 2018 Sep;31(5(Supplementary)):2179-2184.
Paula JJ, Miranda DM, Nicolato R, Moraes EN, Bicalho MA, Malloy-Diniz LF. Verbal learning on depressive pseudodementia: accentuate impairment of free recall, moderate on learning processes, and spared short-term and recognition memory. Arq Neuropsiquiatr. 2013 Sep;71(9A):596-9.
Bieniek KF, van Blitterswijk M, Baker MC, Petrucelli L, Rademakers R, Dickson DW. Expanded C9ORF72 hexanucleotide repeat in depressive pseudodementia. JAMA Neurol. 2014 Jun;71(6):775-81.
Vinet-Couchevellou M, Sauvagnat F. [Pseudodementia, what are we talking about? Part II: From Stertz to Alzheimer: A psychogenic disease after trauma]. Encephale. 2015 Jun;41 Suppl 1:S37-43.
Sekhon S, Patel J, Sapra A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 26, 2023. Late-Life Depression.
Kang H, Zhao F, You L, Giorgetta C, D V, Sarkhel S, Prakash R. Pseudo-dementia: A neuropsychological review. Ann Indian Acad Neurol. 2014 Apr;17(2):147-54.
Tripathi R, Mehrotra S. Pseudo-dementia: A neuropsychological review. Ann Indian Acad Neurol. 2015 Jan-Mar;18(1):123-4.
Sahin S, Okluoglu Önal T, Cinar N, Bozdemir M, Çubuk R, Karsidag S. Distinguishing Depressive Pseudodementia from Alzheimer Disease: A Comparative Study of Hippocampal Volumetry and Cognitive Tests. Dement Geriatr Cogn Dis Extra. 2017 May-Aug;7(2):230-239.
Vaish AK, Jain N, Gutch M, Yadav H. Pseudodementia due to intracranial tuberculomas: an unusual presentation. BMJ Case Rep. 2011 Dec 13;2011
Towsley G, Neradilek MB, Snow AL, Ersek M. Evaluating the Cornell Scale for Depression in Dementia as a proxy measure in nursing home residents with and without dementia. Aging Ment Health. 2012;16(7):892-901.
Laver K, Dyer S, Whitehead C, Clemson L, Crotty M. Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews. BMJ Open. 2016 Apr 27;6(4):e010767.
Rapinesi C, Serata D, Del Casale A, Kotzalidis GD, Mazzarini L, Fensore C, Carbonetti P, Scatena P, Capezzuto S, Moscati FM, Brugnoli R, Tatarelli R, Girardi P. Depressive pseudodementia in the elderly: effectiveness of electroconvulsive therapy. Int J Geriatr Psychiatry. 2013 Apr;28(4):435-8.
Tobe E. Pseudodementia caused by severe depression. BMJ Case Rep. 2012 Dec 14;2012
Gale SA, Acar D, Daffner KR. Dementia. Am J Med. 2018 Oct;131(10):1161-1169.