Pseudodementia and physical findings masking significant psychopathology

In a study of 53 medical-surgical patients who were in extended care and were consecutively referred for psychiatric evaluation, 7 (13%) of the patients had been considered to have unequivocal dementia, yet 3 of them (6% of the total or 43% of those considered demented) were found to have a false-dementing psychiatric disorder. Physical findings contributed to masking the psychopathology, which included psychotic depression with the Ganser symptom in 2 patients and hysterical pseudodementia with depression in 1 patient. Criteria that have been recommended to differentiate pseudodementia from dementia could lead to misdiagnosis in the type of case described, which suggests the need for a typology of depressive pseudodementia.