Table 1.

Differentiating Between Depression, LLD with Cognitive Impairment, and Coexisting Dementia and LLD

Domain	Depression	LLD with Cognitive Impairment	Coexisting Dementia and LLD
Clinical course and history	Onset is fairly well established, short history, often history of previous psychiatry illness	Onset is fairly well established, short history, often history of previous psychiatry illness.	Sudden deterioration in cognitive and functional status in a well-established case of dementia Often negative past psychiatry history
Clinical behavior	Minimal cognitive complaints	Detailed, elaborate complaints of cognitive dysfunction, behavior does not reflect cognitive loss, no nocturnal exacerbation	Little complaints of cognitive loss, struggles with cognitive tasks, behavior compatible with cognitive loss, nocturnal accentuation of dysfunction
Examination finding	Mental status examination shows depressive cognitions, but well preserved memory	Frequently answers—“I don’t know” before even trying, inconsistent memory loss for both recent and remote items, may have particular memory gaps, inconsistent performance in cognitive tasks	Memory loss for recent items worse than for remote items, no specific memory gaps exist, consistent low performance on cognitive tasks
Vascular risk factors (hypertension, diabetes, dyslipidemia)	Infrequent	Often present	Often present
Neuroimaging	Often normal	Often subcortical white matter hyperintensities, medial temporal atrophy	Severe medial temporal atrophy, along with global cortical atrophy

LLD: late-life depression.