Geriatric Psychiatry Practice Questions

Q: Delirium is defined as?

Acute onset of disturbed consciousness. ***Acute onset of disturbed consciousness*** - **Delirium** is characterized by an **acute or subacute onset** of fluctuating attention and cognition, indicating a rapid change from baseline mental status. - The core feature is a **disturbance in attention** and **awareness (consciousness)**, which can manifest as reduced clarity, disorientation, or an inability to focus. *Chronic onset of disturbed consciousness* - **Delirium** is by definition an **acute condition**, not chronic. Chronic conditions affecting consciousness tend to be more stable or progressively worsening over a longer period. - **Chronic disturbances** in consciousness are more indicative of conditions like persistent vegetative state or severe dementia, which have different diagnostic criteria than delirium. *Progressive generalized impairment of intellectual functions and memory without impairment of consciousness* - This description is characteristic of **dementia**, where there is a **gradual decline** in cognitive function (memory, intellect) without the primary disturbance of consciousness seen in delirium. - In **dementia**, alertness is generally preserved, while **delirium** involves a direct impairment of the ability to focus, sustain, or shift attention. *Disorientation without clouding of consciousness* - While **disorientation** can be a feature of delirium, it is not the sole defining characteristic and often occurs in conjunction with **clouding of consciousness** (impaired awareness and attention). - Isolated disorientation without other signs of disturbed consciousness might be seen in other conditions but is not sufficient for a diagnosis of **delirium**.

Q: A 78-year-old woman presents with a progressive decline in daily activity. She gives a history of convulsions and visual hallucinations. She does not talk to anyone and keeps looking at the sky. Pathological examination shows the presence of Lewy bodies within the neurons. What is the most probable diagnosis?

Lewy body dementia. ***Lewy body dementia*** - The presence of **progressive cognitive decline**, **visual hallucinations**, and **convulsions** in an elderly patient is highly indicative of Lewy body dementia. - The definitive pathological finding of **Lewy bodies** within neurons confirms the diagnosis. *Prion disease* - Characterized by rapidly progressive dementia, **myoclonus**, and cerebellar ataxia, without typical visual hallucinations or convulsions. - Pathological examination typically shows **spongiform changes** and accumulation of abnormal prion protein, not Lewy bodies. *Huntington's disease* - Presents with a classic triad of **motor dysfunction** (chorea), psychiatric symptoms, and cognitive decline, typically with an earlier onset (30-50 years). - It is an inherited neurodegenerative disorder, and its pathology involves neuronal loss in the striatum, without Lewy bodies. *Alzheimer's disease* - The most common cause of dementia, characterized by **memory impairment** as an early and prominent feature. - Pathological findings include **amyloid plaques** and **neurofibrillary tangles**, not Lewy bodies, and visual hallucinations are less common or occur later in the disease.

Q: The Confusion Assessment Method (CAM) is used for which of the following?

Delirium. ***Delirium*** - The Confusion Assessment Method (CAM) is a widely used and highly sensitive and specific tool for the rapid identification of **delirium**. - It assesses for acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness. *Schizophrenia* - Schizophrenia is a chronic mental health disorder primarily characterized by **psychosis**, including hallucinations, delusions, and disorganized thought. - While patients with schizophrenia can experience cognitive difficulties, specialized scales like the Positive and Negative Syndrome Scale (PANSS) are used, not the CAM. *Dementia* - Dementia is a gradual and progressive decline in cognitive function, including memory, thinking, and reasoning, severe enough to interfere with daily life. - Tools like the mini-mental state examination (MMSE) or Montreal Cognitive Assessment (MoCA) are used for screening and assessing dementia, not the CAM. *Depression* - Depression is a mood disorder characterized by persistent sadness, loss of interest, and other emotional and physical symptoms. - Assessment tools like the Hamilton Depression Rating Scale (HDRS) or Patient Health Questionnaire-9 (PHQ-9) are used for depression.

Q: Which of the following statements about Alzheimer's disease is false?

Alzheimer's disease is curable.. ***Alzheimer’s disease is curable*** - Alzheimer's disease is currently **incurable**, and treatments primarily focus on managing symptoms and slowing disease progression. - Research is ongoing to find more effective treatments, but there is no known cure yet. *Alzheimer’s disease is a leading cause of cognitive decline.* - Alzheimer's disease is the **most common cause of dementia**, accounting for 60-80% of cases, making it a primary driver of cognitive decline in older adults. - The disease progressively damages brain cells, leading to a decline in memory, thinking, and reasoning abilities. *Alzheimer’s disease causes dementia.* - **Dementia** is the clinical syndrome characterized by significant cognitive decline, and Alzheimer's disease is the most common underlying cause. - The characteristic pathological changes in Alzheimer's (amyloid plaques and neurofibrillary tangles) lead to neuronal damage and the resulting dementia symptoms. *One in 10 people age 65 and older has Alzheimer’s disease* - This statement accurately reflects the prevalence of Alzheimer's disease, as approximately 11.3% of people aged 65 and older in the United States have Alzheimer's dementia. - The risk of developing Alzheimer's disease **increases with age**, making it more common in the older population.

Q: What is the most common cause of delirium?

Infection. ***Infection*** - **Infections**, particularly urinary tract infections (UTIs) or pneumonia, are a very common and often reversible cause of **delirium**, especially in elderly or immunocompromised patients [1]. - The systemic inflammatory response to infection can lead to neuroinflammation and direct effects on brain function, manifesting as acute changes in attention and cognition. *Liver failure* - While **liver failure** can cause **hepatic encephalopathy**, which presents with altered mental status, it typically has a more gradual onset and a different neurochemical profile than acute delirium caused by infection. - Hepatic encephalopathy is characterized by abnormal ammonia metabolism and often includes motor signs like **asterixis**, which are not universally present in delirium from infection. *Belladonna poisoning* - **Belladonna poisoning** (due to **anticholinergic toxicity**) can cause **delirium**, along with a constellation of symptoms like dilated pupils, dry mouth, and tachycardia. - However, it is a specific toxicological cause and not as broad or commonly encountered as infection as a general cause of new-onset delirium in hospitalized or elderly populations. *None of the options* - This option is incorrect because **infection** is indeed a very common and recognized cause of delirium [1].

Q: Which of the following is a key distinguishing feature of delirium compared to dementia?

Acute onset of confusion and disorientation. ***Acute onset of confusion and disorientation*** - Delirium is characterized by a **sudden (acute) onset** of mental status changes, including fluctuations in attention, awareness, and cognition, often presenting as **confusion and disorientation**. - Its symptoms typically develop over hours to days, contrasting sharply with the more chronic and insidious progression of dementia. *Gradual memory loss* - **Gradual memory loss** is a hallmark symptom of **dementia**, a neurocognitive disorder characterized by a progressive decline in cognitive function over months to years. - While memory impairment can occur in delirium, its onset is rapid and associated with a fluctuating course, not a steady decline. *Visual hallucinations* - While visual hallucinations can occur in **delirium**, they are not its most unique distinguishing feature from **dementia**, as they can also be prominent in certain types of dementia, such as **Lewy body dementia**. - The acute, fluctuating nature of **cognitive impairment** is a more defining characteristic of delirium. *Difficulty in recognizing familiar people* - **Prosopagnosia** or the inability to recognize familiar faces, is a symptom that can manifest in advanced stages of **dementia** due to widespread brain atrophy. - While patients with delirium might appear confused or disoriented to the point of not recognizing familiar individuals, this is usually part of a global, acute cognitive impairment and not a primary, isolated deficit.

Q: Which of the following is not typically associated with dementia?

Alteration of consciousness. ***Alteration of consciousness*** - An **alteration of consciousness** is a hallmark feature of **delirium**, which is an acute confusional state, usually fluctuating. - **Dementia** is primarily characterized by a chronic, progressive decline in cognitive function with **clear consciousness**. *Forgetfulness* - **Forgetfulness**, particularly memory loss impacting daily life, is one of the **earliest and most common symptoms** of dementia. - This symptom progressively worsens, affecting short-term and eventually long-term memory. *Reduced personal care* - As dementia progresses, individuals often experience a decline in their ability to perform **activities of daily living (ADLs)**, including personal care. - This can manifest as forgetting to bathe, difficulty dressing, or neglecting personal hygiene due to cognitive impairment. *Loss of neurons in brain* - **Neurodegeneration**, characterized by the **loss of neurons** and synapses in the brain, is the underlying pathological basis of most types of dementia, such as Alzheimer's disease. - This neuronal loss leads to brain atrophy and the cognitive deficits seen in dementia.

Q: In Alzheimer's disease (AD), which of the following is NOT commonly seen in early stages?

Acalculia. ***Acalculia*** - **Acalculia**, the inability to perform mathematical calculations, is a **late-stage feature** of Alzheimer's disease that requires extensive **parietal lobe atrophy**. - Among all the cognitive impairments listed, acalculia appears **latest in the disease progression**, making it the feature **NOT commonly seen in early stages**. *Apraxia* - **Apraxia** (inability to perform learned motor tasks) is a **middle-stage feature** that develops as **premotor and parietal cortices** become involved. - While not an early feature, it appears **earlier than acalculia** in the disease course, typically in moderate stages. *Aphasia* - **Mild anomia** (word-finding difficulty) and **naming problems** are **common early symptoms** of Alzheimer's disease. - This reflects early involvement of **temporal-parietal language areas** and is often one of the first cognitive domains affected after memory. *Agnosia* - **Agnosia** (inability to recognize objects, faces, or sounds) is a **middle-stage feature** that appears as **cortical atrophy progresses**. - While not truly early, it typically develops **before acalculia** as the disease advances from mild to moderate stages.

Q: Which of the following is a distinguishing feature of delirium compared to dementia?

Acute clouding of consciousness. ***Acute clouding of consciousness*** - Delirium is characterized by an **acute onset of impaired attention and awareness**, leading to a fluctuating level of consciousness. - This **clouding of consciousness** is a hallmark distinguishing feature from dementias, which generally preserve consciousness in their early stages. *Persistent impaired judgment* - **Impaired judgment** is a feature seen in both delirium and dementia, making it not a distinguishing factor. - In dementia, judgment impairment tends to be **progressive and persistent**, while in delirium, it fluctuates. *Gradual impaired memory* - **Gradual memory impairment** is a characteristic feature of **dementia**, reflecting its slow, progressive neurodegenerative nature. - Delirium typically has an **acute onset** and may cause temporary memory disturbances, but not a gradual, sustained decline. *Disorganized thought process* - While a **disorganized thought process** can occur in both conditions, it is a more prominent and often fluctuating feature of **delirium**. - In dementia, thought processes may become rigid or fragmented, but the disorganization is typically less abrupt and less prone to rapid fluctuations.

Q: In which of the following psychiatric conditions is floccillation seen?

Delirium. ***Delirium*** - **Floccillation**, or carphologia, is specifically characterized by **purposeless plucking at bedclothes or imaginary objects**, indicative of severe agitation and altered consciousness. - It is a classic sign of **severe delirium**, often seen in critically ill, elderly, or demented patients. *Mania* - Mania presents with elevated mood, increased energy, and racing thoughts, but typically does not involve the disoriented, purposeless movements characteristic of floccillation. - While extreme agitation can occur in mania, it is usually goal-directed or related to the patient's grandiosity or irritability. *Depression* - Depression is characterized by low mood, anhedonia, and psychomotor retardation or agitation, but not by picking at bedclothes. - Psychomotor agitation in depression usually involves pacing or restless movements associated with distress, rather than the disoriented floccillation. *Anxiety disorders* - Anxiety disorders involve excessive worry and fear, with symptoms like restlessness, tension, and hypervigilance. - While patients can be agitated, they generally maintain awareness of their surroundings and typically do not exhibit meaningless motor behaviors like floccillation.

Question 1

Delirium is defined as?

Accepted Answer

Acute onset of disturbed consciousness

Answer

Chronic onset of disturbed consciousness

Answer

Progressive generalized impairment of intellectual functions and memory without impairment of consciousness

Answer

Disorientation without clouding of consciousness

Question 2

A 78-year-old woman presents with a progressive decline in daily activity. She gives a history of convulsions and visual hallucinations. She does not talk to anyone and keeps looking at the sky. Pathological examination shows the presence of Lewy bodies within the neurons. What is the most probable diagnosis?

Accepted Answer

Lewy body dementia

Answer

Prion disease

Answer

Huntington's disease

Answer

Alzheimer's disease

Question 3

The Confusion Assessment Method (CAM) is used for which of the following?

Accepted Answer

Delirium

Answer

Schizophrenia

Answer

Dementia

Answer

Depression

Question 4

Which of the following statements about Alzheimer's disease is false?

Accepted Answer

Alzheimer's disease is curable.

Answer

Alzheimer’s disease causes dementia.

Answer

Alzheimer’s disease is a leading cause of cognitive decline.

Answer

One in 10 people age 65 and older has Alzheimer’s disease

Question 5

What is the most common cause of delirium?

Accepted Answer

Infection

Answer

Liver failure

Answer

Belladonna poisoning

Answer

None of the options

Question 6

Which of the following is a key distinguishing feature of delirium compared to dementia?

Accepted Answer

Acute onset of confusion and disorientation

Answer

Visual hallucinations

Answer

Gradual memory loss

Answer

Difficulty in recognizing familiar people

Question 7

Which of the following is not typically associated with dementia?

Accepted Answer

Alteration of consciousness

Answer

Reduced personal care

Answer

Loss of neurons in brain

Answer

Forgetfulness

Question 8

In Alzheimer's disease (AD), which of the following is NOT commonly seen in early stages?

Accepted Answer

Acalculia

Answer

Apraxia

Answer

Aphasia

Answer

Agnosia

Question 9

Which of the following is a distinguishing feature of delirium compared to dementia?

Accepted Answer

Acute clouding of consciousness

Answer

Persistent impaired judgment

Answer

Gradual impaired memory

Answer

Disorganized thought process

Question 10

In which of the following psychiatric conditions is floccillation seen?

Accepted Answer

Delirium

Answer

Mania

Answer

Depression

Answer

Anxiety disorders

Geriatric Psychiatry — MCQs

Geriatric Psychiatry — MCQs

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