A number of studies have looked at depression and associated cognitive impairment. The term depressive pseudodementia has proved to be a popular clinical concept. Despite the improvement following treatment of depression, the baseline level of cognitive impairment in older depressive patients remained impaired, mostly. These patients would be likely at high risk of developing progressive dementia. Depressive symptoms and cognitive decline would be different phenotypes result from neurodegeneration of pathophysiology for dementia. Depression in elderly patients, especially late-onset appears to be a strong predictor of dementia. No more concept of pseudodementia, older patients with depressive symptoms combined cognitive impairment should probably have full dementia screenings, comprehensive cognitive testing and ongoing monitoring of their cognitive function.
Aged* ; Dementia ; Depression* ; Factitious Disorders ; Humans ; Mass Screening ; Phenotype

The clinical features of elderly depression are similar to those of younger's, but there are some differences in frequency. First, compared with younger adults, elderly depressive patients are more likely to show melancholic feature. They complain more physical symptoms rather than depressive mood, so they are occasionally regarded as having "atypical depression". Second, geriatric depression frequently has psychotic feature, especially delusion of guilt or nihilism. Finally sometimes they may have decline of cognitive functions, i.e. pseudodementia, so it is important and hard to distinghush it from dementia. In the case that have longer duration of episode, severe depression, non-melancholic symptoms, or delusion, illness is prone to be chronic and develop dementia. Bipolar disorder in elderly is also similar to that in adults in overall clinical manifestation, but has some differences in the following ponits;fewer hyperactivity, fewer thought problem, and less association with life-event. Also, manic delirium is frequent in elderly. The prognosis of elderly mania is various.
Adult ; Aged* ; Bipolar Disorder ; Delirium ; Delusions ; Dementia ; Depression ; Factitious Disorders ; Guilt ; Humans ; Mood Disorders* ; Prognosis*

The clinical features of elderly depression are similar to those of younger's, but there are some differences in frequency. First, compared with younger adults, elderly depressive patients are more likely to show melancholic feature. They complain more physical symptoms rather than depressive mood, so they are occasionally regarded as having "atypical depression". Second, geriatric depression frequently has psychotic feature, especially delusion of guilt or nihilism. Finally sometimes they may have decline of cognitive functions, i.e. pseudodementia, so it is important and hard to distinghush it from dementia. In the case that have longer duration of episode, severe depression, non-melancholic symptoms, or delusion, illness is prone to be chronic and develop dementia. Bipolar disorder in elderly is also similar to that in adults in overall clinical manifestation, but has some differences in the following ponits;fewer hyperactivity, fewer thought problem, and less association with life-event. Also, manic delirium is frequent in elderly. The prognosis of elderly mania is various.
Adult ; Aged* ; Bipolar Disorder ; Delirium ; Delusions ; Dementia ; Depression ; Factitious Disorders ; Guilt ; Humans ; Mood Disorders* ; Prognosis*

Factitious Disorders ; diagnosis ; etiology ; Female ; Humans ; Language ; Middle Aged ; Parkinsonian Disorders ; complications ; Syndrome

We describe a case of thyroid storm due to thyrotoxicosis factitia, which was caused by the ingestion of excessive quantities of exogenous thyroid hormone for the purpose of reducing weight. An 18-year-old female was admitted to the hospital 24 hours after taking up to 50 tablets of synthyroid (1 tablet of synthyroid : levothyroxine 100 microgram). Because of her stuporous mental state and acute respiratory failure, she was intubated and treated in the intensive care unit. After reviewing her history carefully and examining plasma thyroid hormone levels, we diagnosed this case as a thyroid storm due to thyrotoxicosis factitia. Her thyroid function test revealed that T3 was 305 ng/dL, T4 was 24.9 microgram/dl, FT4 was 7.7 ng/dL, TSH was 0.05 micro IU/mL and TBG was 12.84 microgram/mL (normal range: 11.3 - 28.9). TSH receptor antibody, antimicrosomal antibody, and antithyroglobulin antibody were negative. She was recovered by treatment, namely, steroid and propranolol, and was discharged 8 days after admission. Thyroid storm due to thyrotoxicosis factitia caused by the ingestion of excessive thyroid hormone is rarely reported worldwide. Therefore, we now report a case of thyroid storm that resulted from thyrotoxicosis factitia caused by the ingestion of a massive amount of thyroid hormone over a period of 6 months.
Adolescent ; Factitious Disorders/*complications ; Female ; Human ; Thyroid Crisis/*etiology ; Thyroid Hormones/*poisoning ; Thyrotoxicosis/*complications

Factitious fever has been a rare cause of fever of unknown origin. We herein report a case of a young soldier, who presented with persistent fever of unusual pattern and bullae on both palms. After numerous investigations had excluded organic diseases, factitious fever was diagnosed with measurement of the freshly voided urine temperatures and body temperatures while directly observed. Biopsy of skin lesions revealed friction blister. Early recognition of this cause of fever is needed to avoid the unnecessary investigation and prolonged hospitalization.
Biopsy ; Blister ; Body Temperature ; Factitious Disorders ; Fever of Unknown Origin ; Fever* ; Friction ; Hospitalization ; Humans ; Military Personnel ; Skin

OBJECTS: Through comparison of the 99mTc-HMPAO SPECT image of depressive pseudo-dementia group with those of control group(depression group free from cognitive unpairment) and DAT(Dementia of Alzheimer's type), we tried to see part of pathophysiology of the depressive pseudodementia of the elderly. METHODS: The subjects consisted off patients with dementia of Alzheimer type(DAT group), 7 patients with depression free from cognitive impairment(depression group), 7 patients with depressive pseudodementia(depressive pseudodementia group), and 4 normal controls. Depression patients were diagnosed according to DSM III-R DAT patients were diagnosed by DSM III-R and NINCDS-ADRDA criteria of DAT. All were rated with Hamilton Rating Scale for Depression and Mini Mental State Exam. All underwent 99mTc-HMPAO SPECT scan. The images of each group were analysed using SPM of Friston, which compares the images on voxel-by-voxel basis. RESULTS: The results were as follows 1) DAT group showed significant decrease in cerebral blood flow (CBF) compared with controls in the right frontal region, the right temporal region, and both temporal regions(p<0.05). 2) Depression group showed significant decrease in CBF in the left frontal region(p<0.05). 3) Depressive pseudodementia group showed significant decrease in CBF compared with controls in the right temporal region and the left parietal region(p<0.05). 4) Depressive pseudodementia group showed significant decrease in CBF compared with depression group in the right temporal region and both parietal regions(p<0.05). CONCLUSION: Depressive pseudodementia group showed decreased CBF in temporo-parietal region, similar to that of the DAT group. This result supports the hypothesis that depressive psuedodementia includes a subgroup of patients with early-stage primary dementia.
Aged* ; Brain* ; Dementia ; Depression ; Factitious Disorders* ; Humans ; Rabeprazole ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon*

Bacterial Infections ; complications ; Diagnosis, Differential ; Factitious Disorders ; complications ; Fever of Unknown Origin ; diagnosis ; etiology ; psychology ; Humans ; Vasculitis ; complications ; Virus Diseases ; complications

Dementia is a major burden for many countries including South Korea, where life expectancy is continuously growing and the proportion of aged people is rapidly growing. Neurodegenerative disorders, such as, Alzheimer disease, dementia with Lewy bodies, frontotemporal dementia, Parkinson disease, progressive supranuclear palsy, corticobasal degeneration, Huntington disease, can cause dementia, and cerebrovascular disease also can cause dementia. Depression or hypothyroidism also can cause cognitive deficits, but they are reversible by management of underlying cause unlike the forementioned dementias. Therefore these are called pseudodementia. We are entering an era of dementia care that will be based upon the identification of potentially modifiable risk factors and early disease markers, and the application of new drugs postpone progression of dementias or target specific proteins that cause dementia. Efficient pharmacologic treatment of dementia needs not only to distinguish underlying causes of dementia but also to be installed as soon as possible. Therefore, differential diagnosis and early diagnosis of dementia are utmost importance. F-18 FDG PET is useful for clarifying dementing diseases and is also useful for early detection of the diseases. Purpose of this article is to review the current value of FDG PET for dementing diseases including differential diagnosis of dementia and prediction of evolving dementia.
Alzheimer Disease ; Dementia* ; Dementia, Vascular ; Depression ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Factitious Disorders ; Frontotemporal Dementia ; Huntington Disease ; Hypothyroidism ; Korea ; Lewy Bodies ; Life Expectancy ; Neurodegenerative Diseases ; Parkinson Disease ; Risk Factors ; Supranuclear Palsy, Progressive