Geriatric Psychiatry Practice Questions

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.

Q: Which of the following is not a common symptom of Alzheimer's disease?

Cerebral infarcts. ***Cerebral infarcts*** - While **cerebral infarcts** (strokes) can cause cognitive impairment (vascular dementia), they are not a defining or common symptom of Alzheimer's disease itself. - Alzheimer's is characterized by distinct **neurodegenerative changes** (amyloid plaques, neurofibrillary tangles), not typically acute vascular events. *Memory loss* - **Memory loss**, particularly of recent events, is often the earliest and most prominent symptom of Alzheimer's disease, significantly impacting daily life. - This progressive decline in episodic memory is a core diagnostic criterion. *Delusions* - **Delusions**, such as paranoid thoughts or beliefs that things are being stolen, can occur in the moderate to late stages of Alzheimer's disease. - These psychotic symptoms are often a source of distress for both the patient and caregivers. *Apraxia and aphasia* - **Apraxia** (difficulty with learned movements despite normal motor function) and **aphasia** (language difficulties, including word-finding problems) are common cognitive deficits in Alzheimer's. - These symptoms reflect diffuse cortical dysfunction as the disease progresses beyond memory centers.

Q: Which of the following non-memory cognitive symptoms can be associated with Alzheimer's disease (AD)?

All of the options. ***All of the options*** - Alzheimer's disease is characterized by a decline in various cognitive domains, extending beyond memory impairment to include **aphasia**, **apraxia**, and **agnosia**. - These non-memory symptoms become increasingly prominent as the disease progresses and are essential for a comprehensive diagnostic evaluation. *Aphasia* - **Aphasia**, or difficulty with language production or comprehension, is a common non-memory cognitive symptom in AD. - Patients may struggle to find words, understand spoken or written language, or produce coherent sentences. *Apraxia* - **Apraxia**, the inability to perform learned motor movements despite intact motor function and comprehension, is frequently observed in AD. - This can manifest as difficulty with activities of daily living, such as dressing, eating, or using tools. *Agnosia* - **Agnosia**, the inability to recognize objects, people, sounds, shapes, or smells despite intact sensory function, is another non-memory cognitive deficit seen in AD. - Patients may not recognize familiar faces or common household items.

Question 1

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

Accepted Answer

Delirium

Answer

Schizophrenia

Answer

Dementia

Answer

Depression

Question 2

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 3

What is the most common cause of delirium?

Accepted Answer

Infection

Answer

Liver failure

Answer

Belladonna poisoning

Answer

None of the options

Question 4

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 5

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 6

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 7

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 8

In which of the following psychiatric conditions is floccillation seen?

Accepted Answer

Delirium

Answer

Mania

Answer

Depression

Answer

Anxiety disorders

Question 9

Which of the following is not a common symptom of Alzheimer's disease?

Accepted Answer

Cerebral infarcts

Answer

Memory loss

Answer

Delusions

Answer

Apraxia and aphasia

Question 10

Which of the following non-memory cognitive symptoms can be associated with Alzheimer's disease (AD)?

Accepted Answer

All of the options

Answer

Aphasia

Answer

Apraxia

Answer

Agnosia

Geriatric Psychiatry — MCQs

Geriatric Psychiatry — MCQs

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