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Case Reports
. 2022 Oct 6;12(10):1665.
doi: 10.3390/jpm12101665.

Depressive Pseudodementia with Reversible AD-like Brain Hypometabolism: A Case Report and a Review of the Literature

Federico Emanuele Pozzi  1 , Daniele Licciardo  2 , Monica Musarra  3 , Lorenzo Jonghi-Lavarini  3 , Cinzia Crivellaro  3 , Gianpaolo Basso  4 , Ildebrando Appollonio  1   5 , Carlo Ferrarese  1   5
Affiliations
Case Reports

Depressive Pseudodementia with Reversible AD-like Brain Hypometabolism: A Case Report and a Review of the Literature

Federico Emanuele Pozzi et al. J Pers Med. .

Abstract

Recent European guidelines recommend using brain FDG-PET to differentiate between Alzheimer's disease (AD) and depressive pseudodementia (DP), with specific hypometabolism patterns across the former group, and typically normal or frontal hypometabolism in the latter. We report the case of a 74 years-old man with DP (MMSE 16/30), whose FDG-PET visual rating and semiquantitative analysis closely mimicked the typical AD pattern, showing severe hypometabolism in bilateral precuneus, parietal and temporal lobes, and sparing frontal areas, suggesting the diagnosis of moderate AD. Shortly after starting antidepressant polytherapy, he underwent formal NPS testing, which revealed moderate impairment of episodic memory and mild impairment on executive and visuospatial tests, judged consistent with neurodegenerative dementia and concomitant depression. Over the following two years, he improved dramatically: repeated NPS assessment did not show significant deficits, and FDG-PET showed restoration of cerebral metabolism. The confirmation of PET findings via semiquantitative analysis, and their reversion to normality with antidepressant treatment, proved the non-neurodegenerative origin of the initial AD-like FDG-PET abnormalities. We review similar cases and provide a comprehensive analysis of their implications, concluding that reversible FDG-PET widespread hypometabolism might represent a biomarker of pseudodementia. Therefore, we suggest caution when interpreting FDG-PET scans of depressed patients with cognitive impairment.

Keywords: Alzheimer’s disease; FDG-PET; case report; depression; pseudodementia; reversible hypometabolism.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
FDG-PET after the first neurological evaluation.
Figure 2
Figure 2
Imaging findings at last follow up: (a) Brain MRI—upper panels showing axial FLAIR slices, lower panel showing normal brain perfusion on axial arterial spin labeling slices; (b) FDG-PET.
Figure 3
Figure 3
Semiquantitative analysis with SPM 12 of the first FDG-PET, showing bilateral temporo-parietal hypometabolism.
See this image and copyright information in PMC

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