Citalopram, depression and pseudo dementia: A neuropsychological case study

Abstract

SUMMARY -The author presents a case of (depressive) pseudo dementia, commenting on the clinical and neuropsychological findings before and after the use of citalopram, a serotoninergic anti depressive drug. The case portrays the current criticism about the old dichotomy between non-reversible ("functional") and reversible ("organic") dementia. The 73 year old woman initially diagnosed as pseudo demented showed some mild cognitive deterioration in neuropsychological evaluation after the improvement of her depressive symptoms. Some reasons for the divergent findings on pseudo dementia prognosis in the literature are proposed. KEY-WORDS: depression, dementia, pseudo dementia, citalopram.Citalopram, depressão e pseudodemência: um estudo neuropsicológico de caso.RESUMO: O autor apresenta um caso de pseudodemência depressiva, tecendo comentários sobre os achados clínicos e neuropsicológicos antes e depois do uso de citalopram, um agente serotoninérgico. O caso apresentado ilustra as críticas atuais acerca da antiga dicotomia entre demências reversíveis ("funcionais") e não-reversíveis ("orgânicas"). A paciente de 73 anos inicialmente diagnosticada como pseudodemente demonstrou algum grau de deterioração cognitiva em testes neuropsicológicos após a melhora dos sintomas depressivos. São sugeridas algumas razões para os achados divergentes com relação ao prognóstico da pseudodemência encontrados na literatura. PALAVRAS-CHAVE: depressão, demência, pseudodemência, citalopram.Since the mid-nineteenth century, medicine has estabilished a dichotomy between the "reversible", "functional" or "non-organic" dementia on one side and the "irreversible", "structural" or "organic" on the other side. The term "pseudo dementia", has been widely used in the literature, comprising a broad class of disorders which historically includes not only depressive dementia but also schizophrenia, Ganser syndrome, delirium, normal-pressure hydrocephalus, deafness and much more 2 . The pseudo dementia clinical picture can be present in a number of psychiatric disorders, of which depression is by far the most common. Nowadays the term is commonly used to refer to patients with a depressive syndrome mimicking dementia but for whom this last diagnosis is abandoned because of the course of the illness. Some authors employ the terms depressive and non-depressive pseudo dementia 11 . This dichotomy has been based upon the presumption that the cognitive impairment seen in pseudo dementia, although having the appearance of organic deterioration, could remit with proper