Geriatric Psychiatry Practice Questions

Q: An elderly woman is brought to psychiatry OPD by her daughter with complaints of forgetfulness. For the past one year, she has been seeing people and animals in nearby house that has been unoccupied during this period. Also has rigidity. What is the mos t likely type of dementia?

Lewy body dementia. ***Lewy body dementia*** - Characterized by the clinical triad of **visual hallucinations** (often of people or animals), **fluctuating cognition**, and **parkinsonism** (such as rigidity). - Diagnosis relies on the presence of these core features and the **dementia** occurring within a year of the onset of motor symptoms. *Alzheimer’s disease* - Primarily presents with **progressive memory loss** and executive dysfunction without early prominent motor features. - **Visual hallucinations** are typically a late-stage finding rather than an early, characteristic feature like in Lewy body dementia. *Parkinson’s disease* - Features **tremor**, **rigidity**, and **bradykinesia** as the primary symptoms, with cognitive decline occurring much later in the disease course. - If cognitive impairment occurs within one year of motor symptoms, it is clinically classified as **Dementia with Lewy Bodies** (DLB) rather than **Parkinson's Disease Dementia**. *Vascular dementia* - Characterized by a **stepwise decline** in cognitive function associated with **cerebrovascular disease** or stroke events. - Clinical findings usually show **focal neurological deficits** rather than the specific pattern of hallucinations and parkinsonism seen here.

Q: An elderly patient dies, and autopsy reveals neuritic plaques in the brain. What is the most likely diagnosis?

Alzheimer’s disease. ***Alzheimer’s disease*** - The presence of **neuritic plaques** (composed of extracellular **beta-amyloid** deposits) and **neurofibrillary tangles** (intracellular hyperphosphorylated **tau protein**) is the pathologic hallmark of **Alzheimer’s disease**. - These findings lead to widespread **cortical atrophy**, particularly in the **hippocampus** and temporal lobes, correlating with the progressive dementia seen in this condition. *Parkinson’s disease* - The pathological hallmark is **Lewy bodies**, which are intracellular inclusions of **alpha-synuclein** found primarily in the **substantia nigra**. - Clinically manifests with motor symptoms like **bradykinesia**, **resting tremor**, and **rigidity** rather than primarily memory loss. *Creutzfeldt-Jakob disease* - Characterized pathologically by **spongiform changes** (vacuolation) in the cerebral cortex and grey matter. - This is a **prion disease** that typically presents with rapidly progressive dementia and **myoclonus**, often showing characteristic **periodic sharp wave complexes** on EEG. *Huntington’s disease* - Pathologically characterized by severe atrophy of the **caudate nucleus** and putamen (striatum) due to neuronal degeneration. - Clinically presents with **chorea**, behavioral disturbances, and dementia, usually displaying an **autosomal dominant** inheritance pattern.

Q: Which of the following antidepressants can be safely used in elderly depression?

Mianserin. In geriatric psychiatry, the choice of antidepressant is dictated by the side-effect profile, specifically the risk of anticholinergic effects, sedation, and cardiovascular complications. **Why Mianserin is correct:** Mianserin is a tetracyclic antidepressant (TeCA) that is frequently preferred in the elderly because it lacks significant **anticholinergic side effects** (which cause confusion, urinary retention, and glaucoma) and has minimal **cardiotoxicity**. It is particularly useful in elderly patients with insomnia or agitation due to its sedative properties, but it does not typically cause the severe orthostatic hypotension seen with older TCAs. **Analysis of Incorrect Options:** * **Fluoxetine (Option C):** While SSRIs are first-line for the elderly, Fluoxetine has a very **long half-life** (and active metabolites) which can lead to accumulation and prolonged side effects (like hyponatremia/SIADH or agitation) in patients with age-related renal or hepatic decline. Sertraline is generally preferred over Fluoxetine in this age group. * **Trazodone (Option A):** Though used for sleep, it is notorious for causing significant **orthostatic hypotension** in the elderly, increasing the risk of falls and hip fractures. * **Phenelzine (Option D):** As a non-selective MAOI, it requires strict dietary restrictions and carries a high risk of **hypertensive crisis** and drug-drug interactions, making it unsafe for the polypharmacy often seen in geriatric patients. **NEET-PG High-Yield Pearls:** * **Drug of Choice:** SSRIs (specifically **Sertraline** or **Escitalopram**) are generally the first-line treatment for elderly depression. * **Mianserin Risk:** Always monitor for **agranulocytosis** (rare but serious). * **Avoid:** Tertiary amines (Amitriptyline, Imipramine) due to high anticholinergic activity. * **Key Concern:** Always check for **hyponatremia** (SIADH) when starting an SSRI in an elderly patient.

Q: Vascular dementia is characterised by all except?

Visual hallucination. **Explanation:** Vascular Dementia (VaD) is the second most common cause of dementia after Alzheimer’s disease. It is caused by chronic cerebral ischemia or multiple infarcts (Multi-infarct dementia). **Why Option A is the Correct Answer:** Visual hallucinations are **not** a characteristic feature of Vascular Dementia. While they can occur in advanced stages or during episodes of delirium, they are the hallmark clinical feature of **Dementia with Lewy Bodies (DLB)**. In DLB, visual hallucinations are typically well-formed, detailed, and occur early in the disease course. **Analysis of Other Options:** * **Memory Deficit (Option B):** This is a core requirement for the diagnosis of any dementia. In VaD, memory loss may be less severe initially compared to Alzheimer’s, often showing a "patchy" distribution of cognitive deficits depending on the location of the strokes. * **Emotional Lability (Option C):** Also known as pseudobulbar affect, this is a classic feature of Vascular Dementia. Patients often exhibit sudden, exaggerated, or inappropriate emotional responses (e.g., uncontrollable crying or laughing) due to the disruption of cortico-bulbar pathways. **NEET-PG High-Yield Pearls:** 1. **Hachinski Ischemic Score:** Used to clinically differentiate VaD from Alzheimer’s. A score **>7** suggests Vascular Dementia. 2. **Step-ladder progression:** VaD typically follows a "step-wise" decline (sudden drops in function followed by plateaus), unlike the gradual, continuous decline in Alzheimer’s. 3. **Neuroimaging:** MRI typically shows multiple infarcts or extensive white matter hyperintensities (leukoaraiosis). 4. **Risk Factors:** Hypertension (most important), diabetes, and smoking. Management focuses on controlling these cardiovascular risks.

Question 1

An elderly woman is brought to psychiatry OPD by her daughter with complaints of forgetfulness. For the past one year, she has been seeing people and animals in nearby house that has been unoccupied during this period. Also has rigidity. What is the mos t likely type of dementia?

Accepted Answer

Lewy body dementia

Answer

Alzheimer’s disease

Answer

Parkinson’s disease

Answer

Vascular dementia

Question 2

An elderly patient dies, and autopsy reveals neuritic plaques in the brain. What is the most likely
diagnosis?

Accepted Answer

Alzheimer’s disease

Answer

Parkinson’s disease

Answer

Creutzfeldt-Jakob disease

Answer

Huntington’s disease

Question 3

Which of the following antidepressants can be safely used in elderly depression?

Accepted Answer

Mianserin

Answer

Trazodone

Answer

Fluoxetine

Answer

Phenelzine

Question 4

Delirium is a disorder of:

Accepted Answer

Cognition

Answer

Thought

Answer

Perception

Answer

Insight

Question 5

Vascular dementia is characterised by all except?

Accepted Answer

Visual hallucination

Answer

Memory deficit

Answer

Emotional liability

Answer

None of the above

Geriatric Psychiatry — MCQs

Geriatric Psychiatry — MCQs

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