Introduction
The term “pseudodementia” has attracted much controversy amongst
clinicians. There is belief that this may be a separate clinical entity
mimicking dementia and characterized by cognitive problems. On the other
hand there is postulation that “pseudodementia” is not an illness but
a purely descriptive entity without any diagnostic implications. In this
report we will discuss our findings in the case of an elderly Caucasian
male who presented at our clinic with symptoms of progressive dementia,
as well as possibly Parkinson’s disease. It appears that he was
initially misdiagnosed with dementia, due to his cognitive limitations,
compounded by poor response to sertraline 50 mg daily, followed by a
trial of donepezil 20 mg daily and memantine 20 mg daily. Behavioral
problems induced by these medications resulted in a clinician adding
paliperidone to his treatment. Side effects induced by paliperidone
further caused another diagnostic error, resulting in the diagnosis of
Parkinson’s disease. Treatment with a combination of L-dopa, amantadine
and ropinirole produced further deterioration of the patient’s symptoms,
possibly due to further side effects. Discontinuation of all the
medications, followed by initiation of selegiline, titrated to high-dose
selegiline therapy at 60 mg per day produced marked cessation of all
symptoms, and restoration of cognition. The patient has been stable on
selegiline at 40 mg per day for the past year.