When an older adult in your life suddenly becomes confused or forgetful, you might presume it to be the first sign of dementia.

It may not be.

If the onset is sudden, it’s more likely pseudodementia, a condition that looks similar to dementia, but is actually masking another health condition, including depression or even a urinary tract infection (UTI). The key difference is how quickly it comes on.

“Dementia has a slower progression,” and Dr. Karen Henrichsen, an internal medicine doctor with Novant Health Buckwalter Place Primary Care in Bluffton, South Carolina, who specializes in geriatric medicine. “Pseudodementia is a sudden onset.”

Patients with Alzheimer’s disease and other forms of dementia exhibit symptoms gradually over time, while pseudodementia appears without warning. But if you’re not seeing your parent every week or so, you may not know if their forgetfulness is sudden. That’s one reason it’s a good idea to check on elderly relatives regularly, Henrichsen said.

At what age do people need start monitoring for pseudodementia?

Pseudodementia is something that can start to occur any time after 60. It’s not something the patient themselves will notice, but a family member or friend probably will.

Since pseudodementia may be masking depression, let’s talk about that. Is depression common in people who are 60 and older?

Our immune systems go down as we get older. Just as your joints never ached before, but now they do, you may start to get the blues. And people who always felt like they had these wonderful lives are left wondering: What's wrong with me? Why can't I get out of this funk?

It’s because the neurotransmitters have dried up. Getting on the right medication can give them back the serotonin or the norepinephrine and make them feel like themselves again.

I’d never heard of pseudodementia. Is it a condition most primary care doctors cover with older patients?

Primary care doctors — especially those in geriatric medicine — will typically discuss it on an as-needed basis when symptoms first start.

But pseudodementia is so highly correlated with depression that doctors know to look for it. If I do a memory test on somebody and they do poorly, they could wind up with a misdiagnosis of mild cognitive impairment.

So, whenever I do a memory screen, I screen for depression at the same time. If my patient scores high on the depression screen and positive for memory impairment, I would treat their depression and bring them back in three months for another memory screen. Usually, once we treat the depression, we’ll see improvement in their memory.

Does the patient experiencing symptoms of pseudodementia usually notice them? Or is this condition usually caught by a spouse, caregiver or the adult children?

It’s almost exclusively the latter.

Can pseudodementia turn into actual dementia?

Good question. No.

I imagine that many people who notice symptoms of pseudodementia assume it’s dementia, right?

Yes. And anybody who works in primary care, urgent care or an ER should be well aware of this condition. If a family member brings in a senior with an acute change in mental status — where they’re confused or getting paranoid —we look for an infection. That’s because, in addition to depression, pseudodementia can be brought on by an infection like a UTI or pneumonia.

Whenever somebody over 70 winds up in the ER with a mental status change and fever, they’ll have their urine checked and get a lung X-ray right away.

Would the person with these symptoms also have symptoms typical of a UTI, such as urgency and a burning sensation when urinating? Or, do these symptoms take the place of those we're more familiar with?

They would most likely not have the traditional dysuria (burning with urination). They may have urinary frequency and/or urgency, but due to delirium, they probably won’t recognize what’s happening.

What about patients who have pneumonia? Will they likely be coughing?

Possibly. But there’s a condition people call “walking pneumonia” that doesn’t involve much coughing but incredible fatigue with a low-grade fever.

If a UTI goes untreated, what could happen?

It could lead to a severe kidney infection, permanent kidney damage and even sepsis, a life-threatening bloodstream infection. So, this can be a very serious condition.

If your elderly parent or anyone you care about suddenly — and suddenly is key here — begins exhibiting signs of dementia, it’s important to get them to a doctor at once.

Is there anything else that could be mistaken for dementia?

You’ll sometimes hear that statins cause dementia. They do not.

But it’s possible to have short-term, dementia-like symptoms when you first start taking a statin. As soon as you stop the statin, it completely reverses. This is incredibly rare; I've had just two cases in the 18-plus years I’ve been practicing.

What can people do to prevent pseudodementia?

The best way to prevent delirium with UTI is for family members to check in on their geriatric relatives. It’s important to get them to the doctor quickly to prevent further illness and worsening of symptoms.

If someone brought in their elderly mother and said, “She’s not right. I can’t really put my finger on it, but she seems depressed or a little angry,” the first thing I’d do is get a urine sample and then screen for depression.

I can’t emphasize enough how important it is to check in regularly with, and be attentive to, your older relatives. That’s in part because they, like all of us, need social interaction. But it’s also to monitor their physical and mental health — particularly for seniors who live alone.