Geriatric Psychiatry Practice Questions

Q: Which of the following is a preventable risk factor for dementia?

Hypertension. **Explanation:** The prevention of dementia is a high-yield topic in geriatric psychiatry. According to the **Lancet Commission on Dementia Prevention**, approximately 40% of dementia cases are attributable to 12 modifiable risk factors. **Why Hypertension is correct:** Mid-life **hypertension** (typically defined as systolic BP ≥140 mmHg) is a major **preventable** risk factor. Chronic high blood pressure leads to cerebrovascular damage, white matter lesions, and microinfarcts, which contribute significantly to both Vascular Dementia and Alzheimer’s Disease. Controlling BP with antihypertensives is proven to reduce the risk of cognitive decline. **Analysis of Incorrect Options:** * **B. Apolipoprotein E4 (ApoE4):** This is a genetic risk factor. While it significantly increases the risk of late-onset Alzheimer’s, it is **non-modifiable**. * **C. Advanced age:** This is the **strongest non-modifiable risk factor** for dementia. The prevalence of dementia doubles every five years after the age of 65. * **D. Lowered homocysteine levels:** High levels of homocysteine (Hyperhomocysteinemia) are associated with increased dementia risk. Therefore, *lowered* levels would be considered protective, not a risk factor. **NEET-PG High-Yield Pearls:** * **Most common cause of dementia:** Alzheimer’s Disease. * **Most common preventable risk factor:** Mid-life hypertension and hearing loss (hearing loss is often cited as the single largest modifiable risk factor in mid-life). * **Other modifiable factors:** Diabetes, obesity, smoking, depression, physical inactivity, and low education levels. * **Protective factors:** High education, physical exercise, and "cognitive reserve."

Q: Vascular dementia is characterized by which of the following?

Memory deficits. **Explanation:** **Vascular Dementia (VaD)** is the second most common cause of dementia after Alzheimer’s disease. According to the **ICD-10 and DSM-5 criteria**, the core clinical feature required for a diagnosis of any dementia, including vascular dementia, is the presence of **memory deficits** along with impairment in at least one other cognitive domain (aphasia, apraxia, agnosia, or executive functioning) that interferes with daily life. * **Why Memory Deficits is Correct:** While VaD often presents with prominent executive dysfunction (due to subcortical involvement), memory impairment remains a fundamental diagnostic requirement. It typically follows a "step-wise" decline resulting from multiple cerebrovascular accidents (infarcts). * **Why other options are incorrect:** * **Disorientation:** While it occurs as dementia progresses, it is a non-specific feature and not the primary diagnostic hallmark. * **Emotional lability:** Also known as "pseudobulbar affect," this is common in VaD due to frontal-subcortical disruption, but it is a supportive clinical sign rather than a defining diagnostic criterion. * **Visual hallucinations:** These are highly characteristic of **Lewy Body Dementia (LBD)** and are not a primary feature of vascular dementia. **High-Yield Clinical Pearls for NEET-PG:** * **Hachinski Ischemic Score:** A score >7 suggests Vascular Dementia; <4 suggests Alzheimer’s. * **Key Presentation:** Step-wise deterioration, focal neurological deficits (e.g., hemiparesis, gait changes), and "patchy" cognitive deficits. * **Risk Factors:** Hypertension (most significant), diabetes, and smoking. * **Neuroimaging:** MRI typically shows multiple infarcts or extensive white matter hyperintensities (leukoaraiosis).

Q: A 68-year-old male presents with a 6-month history of increasing forgetfulness, difficulty organizing finances and paying bills, social withdrawal, and recent inappropriate behavior towards a neighbor. His wife reports these changes are uncharacteristic. He has a history of hypertension and type 2 diabetes mellitus, and a family history of Alzheimer disease. His Mini-Mental State Examination (MMSE) score is 23. What is the most likely diagnosis?

Frontotemporal dementia. ### Explanation **Correct Answer: D. Frontotemporal Dementia (FTD)** The clinical presentation highlights a significant shift in **personality and social conduct** (inappropriate behavior, social withdrawal) alongside executive dysfunction (difficulty organizing finances), which are the hallmarks of the **behavioral variant of Frontotemporal Dementia (bvFTD)**. In FTD, behavioral changes and executive deficits often precede significant memory loss. The patient's "uncharacteristic" inappropriate behavior toward a neighbor indicates **loss of social inhibition**, a classic diagnostic feature. While the MMSE score (23) indicates cognitive impairment, the focal involvement of the frontal lobes explains the early decline in social cognition and executive function. **Why incorrect options are wrong:** * **A. Alzheimer Disease:** Typically presents with **early episodic memory loss** (forgetting recent events). While this patient has forgetfulness, the prominent early personality changes and social disinhibition point more strongly toward FTD. * **B. Creutzfeldt-Jakob Disease:** Characterized by **rapidly progressive** dementia (weeks to months) usually accompanied by myoclonus and ataxia. A 6-month course with primary behavioral symptoms is less typical. * **C. Dementia with Lewy Bodies (DLB):** Requires the presence of **visual hallucinations**, parkinsonism, and fluctuating levels of consciousness. None of these are present here. **High-Yield Clinical Pearls for NEET-PG:** * **FTD vs. Alzheimer’s:** FTD occurs at a younger age (typically 45–65) and presents with "Personality first, Memory later." Alzheimer’s is "Memory first, Personality later." * **Pick’s Disease:** A subtype of FTD characterized histologically by **Pick bodies** (silver-staining tau inclusions) and **Knife-edge atrophy** of the frontal and temporal lobes. * **Neuroimaging:** Look for selective atrophy of the frontal and anterior temporal lobes on MRI.

Q: Which of the following disorders is characterized by intense nihilism, somatization and agitation in old age?

Involutional melancholia. ***Involutional melancholia*** - This term refers to a severe depressive disorder in **late adulthood** characterized by profound **nihilism** (belief in the meaninglessness of existence), **somatization** (physical symptoms without a physical cause), and **agitation**. - It often involves prominent **psychotic features** like delusional guilt, nihilistic delusions (e.g., believing one's organs are rotting), and severe anxiety, distinguishing it from other forms of depression in older adults. - **Note**: This is a **historical diagnostic term** no longer used in DSM-5/ICD-11. The condition is now classified as **Major Depressive Disorder with melancholic features** or **with psychotic features** (when delusions are present). *Atypical depression* - Characterized by mood reactivity (mood improves in response to positive events), **increased appetite**, **hypersomnia**, leaden paralysis, and interpersonal rejection sensitivity. - This presentation is largely opposite to the **agitation** and severe **nihilism** seen in the described disorder. *Bipolar depression* - Occurs as part of **bipolar disorder**, involving episodes of both depression and mania/hypomania. - While it can be severe, the specific constellation of **intense nihilism**, prominent **somatization**, and persistent **agitation** in old age is more characteristic of what was historically termed involutional melancholia. *Somatized depression* - Refers to depression where **physical symptoms** are prominent. While somatization is present in the question, the defining features of **intense nihilism** and **agitation** are not specific to somatized depression. - This term usually emphasizes the physical presentation, whereas involutional melancholia describes a broader, severe depressive syndrome typical of later life.

Q: Which of the following is not a feature of delirium?

Intact attention. ***Intact attention*** - Delirium is fundamentally characterized by an **acute disturbance of attention** and awareness, making intact attention an incorrect feature. - Patients with delirium often struggle to focus, sustain, or shift attention, leading to disorientation and difficulty with cognitive tasks. *Disturbed sleep* - **Sleep-wake cycle disturbances** are a common feature of delirium, often manifesting as insomnia, hypersomnia, or reversal of the sleep cycle. - This disordered sleep pattern contributes to the overall cognitive impairment and agitation seen in delirious patients. *Illusion* - **Perceptual disturbances**, including illusions and hallucinations (especially visual), are hallmark symptoms of delirium. - Patients misinterpret real sensory stimuli (illusions) or perceive things that are not present (hallucinations). *Memory loss* - While not the primary deficit, **memory impairment**, particularly for recent events, is a significant feature of delirium due to the global cognitive dysfunction. - Patients often have difficulty recalling events that occurred during the delirious episode when they recover.

Question 1

Which of the following is a preventable risk factor for dementia?

Accepted Answer

Hypertension

Answer

Apolipoprotein E4

Answer

Advanced age

Answer

Lowered homocysteine levels

Question 2

Vascular dementia is characterized by which of the following?

Accepted Answer

Memory deficits

Answer

Disorientation

Answer

Emotional lability

Answer

Visual hallucinations

Question 3

True about dementia is:

Accepted Answer

Dementia is the loss of distant memory.

Answer

Alzheimer's disease is due to multiple small strokes in the cerebral cortex.

Answer

Dementia due to atherosclerosis does not progress like Alzheimer's.

Answer

Alzheimer's disease is associated with an increase in acetylcholine release in the cerebral cortex.

Question 4

An elderly widow reports auditory hallucinations of her deceased husband speaking to her. She often discusses daily matters with him, which provokes anxiety and sadness. What is the most appropriate initial treatment for this patient?

Accepted Answer

Haloperidol

Answer

Clomipramine

Answer

Alprazolam

Answer

Electroconvulsive therapy

Question 5

Which of the following are treatable causes of dementia?

Accepted Answer

Multi-infarct dementia

Answer

Alzheimer's disease

Answer

Hypothyroidism

Answer

Subdural hematoma
Hydrocephalus

Question 6

A 68-year-old male presents with a 6-month history of increasing forgetfulness, difficulty organizing finances and paying bills, social withdrawal, and recent inappropriate behavior towards a neighbor. His wife reports these changes are uncharacteristic. He has a history of hypertension and type 2 diabetes mellitus, and a family history of Alzheimer disease. His Mini-Mental State Examination (MMSE) score is 23. What is the most likely diagnosis?

Accepted Answer

Frontotemporal dementia

Answer

Alzheimer disease

Answer

Creutzfeldt-Jakob disease

Answer

Dementia with Lewy bodies

Question 7

Alzheimer's disease is associated with:

Accepted Answer

Dementia

Answer

Delerium

Answer

Delusion

Answer

All of the above

Question 8

Which of the following disorders is characterized by intense nihilism, somatization and agitation in old age?

Accepted Answer

Involutional melancholia

Answer

Atypical depression

Answer

Bipolar depression

Answer

Somatized depression

Question 9

True about dementia is:

Accepted Answer

Dementia involves a decline in memory and other cognitive functions affecting daily living

Answer

Dementia due to atherosclerosis progresses in the same gradual manner as Alzheimer's disease

Answer

Alzheimer's disease is due to multiple small strokes in the cerebral cortex

Answer

Alzheimer's disease is associated with an increase in ACh release in the cerebral cortex

Question 10

Which of the following is not a feature of delirium?

Accepted Answer

Intact attention

Answer

Disturbed sleep

Answer

Illusion

Answer

Memory loss

Geriatric Psychiatry — MCQs

Geriatric Psychiatry — MCQs

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