The current case describes a 78-year-old female with two previous episodes of major depression who presented with both symptoms of depression (amotivation and flattened affect) and typical symptoms of dementia (impaired memory and executive functioning). Even after a detailed clinical exam and neuropsychiatric testing, it remained difficult to definitively classify the diagnosis as either treatment-resistant depression or old-age dementia. After 8 weeks of inpatient treatment, including changing her reserpine-based antihypertensive medication, adjusting her antidepressants, and providing psychotherapy, her depressive and anxiety symptoms improved, but most of her cognitive symptoms persisted. Her symptoms did not change over 7 months of post-hospitalization follow-up. She subsequently developed advanced breast cancer and started chemotherapy; at this point her depressive and cognitive symptoms became more pronounced. We conclude that it will take two-to-three years of follow-up to determine whether the cognitive symptoms are residual to her depression or a newly emerging dementia (or both). This case shows that for elderly patients who have symptoms of both depression and dementia, detailed clinical examination and neuropsychiatric testing may need to be combined with longitudinal assessment of their responsiveness to treatment before a definitive diagnosis can be assigned.
概述: 抑郁伴痴呆在老年人中日益普遍。本报告描述了一个78岁的女性患者，先前有过两次抑郁发作，本次存在抑郁症状（动力缺乏和情感淡漠）和典型的痴呆症状（记忆力和执行功能受损）。即使经过详细的临床检查和神经心理测量，仍然难以明确诊断是难治性抑郁症还是老年痴呆。经过8周的住院治疗，更改了原先以利血平为主的降压药，调整抗抑郁药并予心理治疗，患者的抑郁和焦虑症状改善，但大多数认知症状仍然持续存在。在出院后7个月的随访中，这些症状也没有变化。随后，她出现了晚期乳腺癌并开始化疗，此时她的抑郁症状和认知症状更加明显。我们认为，需要2~3年的随访才可以确定认知症状是抑郁症的残留症状还是新出现的痴呆表现（或两者皆是）。该病例表明对于同时有抑郁症状和痴呆症状的老年患者，不仅需要详细的临床检查和神经心理测试，而且要结合对治疗疗效的长期评估才能明确诊断。.
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Keywords: China; case report; dementia; depression; pseudo-dementia.