Dementia or depression? Diagnostic bias in geriatric practice

The distinction between dementia and depression in the care of older adults is a common challenge made more difficult when other illnesses and medications confound the task. Practitioners are subject to biases resulting from the frequency with which they encounter clinical syndromes as well as pride in "making the diagnosis," particularly when the disease is rare. The following is a case in which one diagnosis was accurately rejected but the correct diagnosis was missed. This affords an opportunity to examine a common clinical problem with an uncommon cause in geriatric practice.