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Major Depressive Disorder with Psychotic Features May Lead to Misdiagnosis of Dementia: A Case Report and Review of the Literature

Wagner, Gerhardt S. MD, PhD*; McClintock, Shawn M. PhD; Rosenquist, Peter B. MD*; McCall, W. Vaughn MD, MS*; Kahn, David A. MD

Journal of Psychiatric Practice: November 2011 - Volume 17 - Issue 6 - p 432–438
doi: 10.1097/01.pra.0000407968.57475.ab
Clinical Case Discussion

Major depressive disorder (MDD) with psychotic features is relatively frequent in patients with greater depressive symptom severity and is associated with a poorer course of illness and greater functional impairment than MDD without psychotic features. Multiple studies have found that patients with psychotic mood disorders demonstrate significantly poorer cognitive performance in a variety of areas than those with nonpsychotic mood disorders. The Mini Mental State Examination (MMSE) and the Dementia Rating Scale, Second Edition (DRS-2) are widely used to measure cognitive functions in research on MDD with psychotic features. Established total raw score cut-offs of 24 on the MMSE and 137 on the DRS-2 in published manuals suggest possible global cognitive impairment and dementia, respectively. Limited research is available on these suggested cut-offs for patients with MDD with psychotic features. We document the therapeutic benefit of electroconvulsive therapy (ECT), which is usually associated with short-term cognitive impairment, in a 68-year-old woman with psychotic depression whose MMSE and DRS-2 scores initially suggested possible global cognitive impairment and dementia. Over the course of four ECT treatments, the patient’s MMSE scores progressively increased. After the second ECT treatment, the patient no longer met criteria for global cognitive impairment. With each treatment, depression severity, measured by the 24-item Hamilton Rating Scale for Depression, improved sequentially. Thus, the suggested cut-off scores for the MMSE and the DRS-2 in patients with MDD with psychotic features may in some cases produce false-positive indications of dementia. (Journal of Psychiatric Practice 2011;17:432–438)

*Wake Forest University Baptist Medical Center, Winston-Salem, NC

University of Texas Southwestern Medical Center, Dallas, and Columbia University/New York State Psychiatric Institute

Columbia University College of Physicians and Surgeons.

Funding for this research was provided by NIH Grant 1U01MH086127-01.

© 2011 Lippincott Williams & Wilkins, Inc.