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Alzheimer dementia
28%
40/143
Hypothyroidism
6%
8/143
Lewy body dementia
11%
16/143
Normal aging
9%
13/143
Pseudodementia
45%
65/143
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This patient is presenting with SIGE CAPS criteria (Sleep changes, Interest loss, Guilt, decreased Energy, Concentration troubles, Appetite changes, and Psychomotor retardation) and new-onset symptoms of dementia with an inability for the patient to care for herself, suggesting a diagnosis of pseudodementia. Pseudodementia occurs when a patient presents with symptoms of dementia in the setting of major depression. To make this diagnosis, the onset of symptoms is important. Typically, the patient will first present with symptoms of depression and dementia concurrently without a prior history of isolated dementia. The diagnosis of depression can be suspected when a patient suffers a major loss and meets SIGE CAPS criteria (5 of the following: Sleep changes, Interest loss, Guilt, decreased Energy, Concentration troubles, Appetite changes, Psychomotor retardation, and Suicidal ideation). The most important treatment for this patient (aside from ruling out organic etiologies of the patient's symptoms) is to treat the underlying depression, which will fix the dementia. Incorrect Answers: Answer 1: Alzheimer dementia presents with a gradual loss of memory and cognitive ability over years, especially in women. This patient has symptoms of depression and does not have a clear gradual progression of her dementia. Answer 2: Hypothyroidism presents with fatigue, weight gain, bradycardia, scarce lanugo, depression, hyponatremia, and cold intolerance. This patient must have a TSH checked to rule out this simple medical cause; however, it would be unusual for a patient to suddenly become hypothyroid at age 72 after the loss of her husband, making this a less likely diagnosis. Answer 3: Lewy body dementia presents with Parkinsonian symptoms (such as bradykinesia, cogwheel rigidity, hypomimia, and small writing) as well as dementia with visual hallucinations. This patient's slow movements more likely represent psychomotor retardation, which is a finding of depression. Answer 4: Normal aging presents with minor forgetfulness that does not impact the quality of the patient's life. For example, the patient may forget some people's names or simple facts more easily; however, the patient will not forget life-impacting information such as how to get home or remembering to turn off the stove. Bullet Summary: Pseudodementia presents with symptoms of dementia and depression.
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