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.