Geriatric Psychiatry Practice Questions

Q: Which of the following dementia is associated with visual hallucinations?

Lewy body dementia. ***Lewy body dementia*** - **Visual hallucinations**, particularly of well-formed and detailed images, are a **core clinical feature** of Lewy body dementia (LBD). - Other key features include **fluctuating cognition** with pronounced variations in attention and alertness, and **spontaneous parkinsonism**. *AIDS related Dementia* - Primarily presents with cognitive and motor slowing, **apathy**, and difficulty with complex tasks, rather than prominent visual hallucinations. - It is a subcortical dementia caused by **HIV infection** directly affecting the brain. *Mixed dementia* - This typically refers to a combination of **Alzheimer's disease** and **vascular dementia**, where hallucinations are not a prominent or early feature. - While visual hallucinations can occur in advanced stages of any dementia, they are not a defining characteristic of mixed dementia. *Huntington's disease* - Characterized by **chorea**, psychiatric disturbances, and cognitive decline, primarily affecting executive function. - **Visual hallucinations** are not a typical feature of Huntington's disease, although psychiatric symptoms like psychosis can occur.

Q: True about delirium is all Except:

Preserved attention. ***Preserved attention*** - A key feature of **delirium** is a **disturbance in attention**, making it difficult to focus, sustain, or shift attention. - Therefore, **preserved attention** is inconsistent with a diagnosis of delirium. *Hallucination* - **Hallucinations**, particularly visual, are common in delirium and often contribute to the patient's distress and altered perception of reality. - They tend to be vivid, fleeting, and can be frightening. *Disturbed sleep* - **Sleep-wake cycle disturbances** are a hallmark of delirium, often manifesting as insomnia, daytime sleepiness, or a disrupted, fragmented sleep pattern. - This disturbance is part of the global alteration in brain activity. *Disorientation* - **Disorientation**, especially to time, place, and sometimes person, is a frequent symptom of delirium, reflecting the patient's impaired cognitive function. - It indicates a significant impairment in awareness of one's surroundings.

Q: A 70-year-old man presents with a 1-year history of progressive memory loss, difficulty finding words, and getting lost in familiar places. His family reports he sometimes sees people in the room who are not there. On examination, deep tendon reflexes are normal, and the mini-mental state examination score is 20/30. What is the most likely diagnosis?

Alzheimer's disease. ***Alzheimer's disease*** - Alzheimer's disease is characterized by **progressive memory loss**, particularly affecting recent memory and episodic memory. - **Language difficulties** (anomia, word-finding difficulty) and **visuospatial deficits** (getting lost) are common early cognitive symptoms. - **Visual hallucinations** can occur in moderate to advanced stages, though less common than in Lewy body dementia. - The **gradual progressive course** over months to years is typical of Alzheimer's disease. - MMSE of 20/30 indicates moderate cognitive impairment consistent with Alzheimer's dementia. *Dissociative amnesia* - This is a **psychiatric condition** involving memory loss for specific autobiographical information, usually related to psychological trauma. - It does not explain the **progressive cognitive decline**, language difficulties, visuospatial deficits, or hallucinations. - Neurological examination is typically normal, and there is no dementia pattern on cognitive testing. *Schizophrenia* - While schizophrenia can present with **hallucinations and delusions**, it typically manifests in late adolescence or early adulthood, not at age 70. - The primary feature is **psychosis**, not progressive memory loss and cognitive decline. - **Late-onset schizophrenia** is rare and would not explain the prominent memory and visuospatial deficits. *Psychotic disorder* - A primary psychotic disorder would explain **hallucinations** but not the **progressive cognitive decline** affecting memory, language, and visuospatial functions. - The MMSE score of 20/30 indicates significant cognitive impairment beyond what would be expected in a primary psychotic disorder. - The clinical picture suggests a **neurodegenerative process** rather than a primary psychiatric condition.

Q: Dementia is present in all except:

Ganser syndrome. ***Ganser syndrome*** - Ganser syndrome is a **factitious disorder** characterized by approximate answers, not true dementia. - Patients with Ganser syndrome often present with dramatic, but ultimately **nonsensical responses** to simple questions, without a clear underlying organic cause of cognitive decline. *Lewy body* - **Lewy body dementia** is characterized by fluctuating cognition, recurrent visual hallucinations, and spontaneous parkinsonism. - It involves the presence of **Lewy bodies** in cortical and subcortical regions leading to progressive cognitive decline. *Pick's disease* - Pick's disease, a type of frontotemporal dementia, is characterized by language and **behavioral changes** due to neuronal loss. - It results in progressive **atrophy of the frontal and temporal lobes**, leading to profound cognitive deficits over time. *Alzheimer's disease* - **Alzheimer's disease** is the most common cause of dementia, characterized by progressive memory loss and cognitive impairment. - It is pathologically defined by the presence of **amyloid plaques** and **neurofibrillary tangles** in the brain.

Q: Dementia of Alzheimer's type is not associated with one of the following

Cerebral infarcts. ***Cerebral infarcts*** - **Cerebral infarcts** are characteristic of **vascular dementia**, where brain damage is caused by reduced blood flow due to stroke or transient ischemic attacks. - While an individual with Alzheimer's could coincidentally have a stroke, **cerebral infarcts** are not a primary neuropathological feature or an expected clinical association inherent to the progression of Alzheimer's disease itself. *Delusions* - **Delusions**, particularly paranoid delusions (e.g., believing caregivers are stealing from them), are relatively common **psychotic symptoms** that can occur in later stages of Alzheimer's disease. - They are considered a behavioral and psychological symptom of dementia (BPSD) and can significantly impact the patient's and caregiver's quality of life. *Apraxia and aphasia* - **Apraxia** (difficulty with motor tasks despite intact motor function) and **aphasia** (language difficulties) are core **cognitive symptoms** that define Alzheimer's dementia. - These are progressive deficits in executive function, language, and motor skills that lead to functional impairment. *Depressive symptoms* - **Depressive symptoms**, including apathy, anhedonia, and low mood, are highly prevalent in individuals with Alzheimer's disease, particularly in the earlier stages. - They can be a reaction to the cognitive decline and loss of independence, or a direct result of the neurodegenerative process affecting mood-regulating brain regions.

Q: All are true about dementia except:

Always reversible with medication. ***Always reversible with medication*** - While some forms of cognitive impairment are reversible, **dementia** is broadly defined by a cognitive decline that is **progressive** and **irreversible** in most cases, such as in **Alzheimer's disease**. - Medications generally aim to slow progression or manage symptoms, not fully reverse the underlying pathology of most dementias. *Loss of long term memory* - **Long-term memory loss** can occur in the later stages of many dementias, although it is often more prominent than short-term memory loss earlier in some types, like **vascular dementia**. - The disease progression eventually impacts both recent and remote memories. *Impaired learning* - **Impaired learning** is a hallmark symptom of dementia, reflecting the difficulty in acquiring new information. - This is closely linked to deficits in **attention** and **working memory**, crucial for encoding new memories. *Loss of short term memory* - **Short-term memory loss** (difficulty remembering recent events or new information) is often one of the **earliest and most prominent** symptoms of common dementias, particularly **Alzheimer's disease**. - This symptom significantly impacts daily functioning and quality of life.

Q: Regarding Alzheimer's disease which is/are not true :

All of the options. ***Correct Option: All of the options*** - All three statements provided are **incorrect descriptions** of Alzheimer's disease. - In Alzheimer's disease, **short-term memory loss occurs early** (not delayed), **long-term memory is preserved initially** (not lost first), and progression is **gradual and continuous** (not step-ladder pattern). - Since all the statements are "not true" about Alzheimer's, "All of the options" is the correct answer to this negatively worded question. *Incorrect Statement: Initial loss of long term memory* - This is **NOT TRUE** for Alzheimer's disease. - Alzheimer's is characterized by **early impairment of short-term memory** (new memory formation). - Patients struggle to recall recent events or learn new information, while **long-term memories from the past** are preserved until later stages. - Remote memories (childhood, early adulthood) remain relatively intact in early-to-moderate disease. *Incorrect Statement: Step ladder pattern* - This is **NOT TRUE** for Alzheimer's disease. - Alzheimer's progression is typically **gradual, insidious, and continuous** with steady cognitive decline. - A **step-ladder (stepwise) pattern** with sudden declines followed by plateaus is characteristic of **vascular dementia**, resulting from multiple cerebrovascular events. - The stepwise deterioration reflects discrete vascular insults, not the neurodegenerative process of Alzheimer's. *Incorrect Statement: Delayed loss of short term memory* - This is **NOT TRUE** for Alzheimer's disease. - **Short-term memory loss** is one of the **earliest and most prominent symptoms** of Alzheimer's disease, not delayed. - Classic early presentations include difficulty recalling recently learned information, forgetting appointments, repeating questions, and misplacing items. - The hippocampus, critical for forming new memories, is affected early in the disease process.

Q: All are true regarding Fronto-temporal dementia except:

Insight present. ***Insight present*** - In Fronto-temporal dementia (FTD), **insight is typically lost** or severely impaired, particularly in the behavioral variant (bvFTD). Patients often exhibit a profound lack of awareness regarding their behavioral changes and their impact on others. - The presence of insight would argue against a diagnosis of FTD, as it is a hallmark feature of the disease's progression. *Affective symptoms* - **Affective symptoms** such as apathy, anhedonia, and dysphoria are very common in FTD, especially in the behavioral variant. These are often early and prominent features. - Patients may appear emotionally blunted or show inappropriate emotional responses. *Age less than 65 years* - FTD is a relatively common cause of **early-onset dementia**, often manifesting before the age of 65 years. - It frequently affects individuals in their 50s and early 60s, distinguishing it from Alzheimer's disease which typically presents later. *Stereotypic behavior* - **Repetitive, ritualistic, or stereotypic behaviors** are characteristic features of behavioral variant FTD. - Examples include repetitive gestures, ritualistic daily routines, or preoccupation with certain activities or foods.

Q: Not a feature of dementia is -

Loss of sensorium. ***Loss of sensorium*** - **Loss of sensorium** (i.e., altered level of consciousness or awareness) is characteristic of **delirium**, not dementia. - Dementia primarily involves a progressive decline in **cognitive function** while the patient remains alert and aware. *Loss of neurons in brain matter* - **Neurodegeneration**, involving the death and loss of neurons, is a hallmark pathological feature of most common types of **dementia**, such as Alzheimer's disease. - This neuronal loss contributes to the progressive decline in **cognitive abilities**. *Wearing of dirty clothes* - **Neglect of personal hygiene**, including wearing dirty clothes, is a common behavioral symptom in the later stages of **dementia**. - This arises from impaired executive function, **memory deficits**, and loss of insight into self-care. *Forgetfulness* - **Forgetfulness** or **memory impairment** (especially of recent events) is a primary and often initial symptom of **dementia**. - It reflects the progressive degeneration of brain regions crucial for **memory formation** and retrieval.

Question 1

Which of the following dementia is associated with visual hallucinations?

Accepted Answer

Lewy body dementia

Answer

AIDS related Dementia

Answer

Mixed dementia

Answer

Huntington's disease

Question 2

True about delirium is all Except:

Accepted Answer

Preserved attention

Answer

Hallucination

Answer

Disturbed sleep

Answer

Disorientation

Question 3

A 70-year-old man presents with a 1-year history of progressive memory loss, difficulty finding words, and getting lost in familiar places. His family reports he sometimes sees people in the room who are not there. On examination, deep tendon reflexes are normal, and the mini-mental state examination score is 20/30. What is the most likely diagnosis?

Accepted Answer

Alzheimer's disease

Answer

Dissociative amnesia

Answer

Schizophrenia

Answer

Psychotic disorder

Question 4

Dementia is present in all except:

Accepted Answer

Ganser syndrome

Answer

Lewy body dementia

Answer

Pick's disease

Answer

Alzheimer's disease

Question 5

A 65-year-old male is brought to the outpatient clinic with one year illness characterized by marked forgetfulness, visual hallucinations, suspiciousness, personality decline, poor self care and progressive deterioration in his condition. His Mini Mental Status Examination (MMSE) score 21. His most likely diagnosis is:

Accepted Answer

Dementia

Answer

Schizophrenia

Answer

Depression

Answer

Mania

Question 6

Dementia of Alzheimer's type is not associated with one of the following

Accepted Answer

Cerebral infarcts

Answer

Delusions

Answer

Apraxia and aphasia

Answer

Depressive symptoms

Question 7

All are true about dementia except:

Accepted Answer

Always reversible with medication

Answer

Loss of long term memory

Answer

Impaired learning

Answer

Loss of short term memory

Question 8

Regarding Alzheimer's disease which is/are not true :

Accepted Answer

All of the options

Answer

Initial loss of long term memory

Answer

Step ladder pattern

Answer

Delayed loss of short term memory

Question 9

All are true regarding Fronto-temporal dementia except:

Accepted Answer

Insight present

Answer

Affective symptoms

Answer

Age less than 65 years

Answer

Stereotypic behavior

Question 10

Not a feature of dementia is -

Accepted Answer

Loss of sensorium

Answer

Loss of neurons in brain matter

Answer

Wearing of dirty clothes

Answer

Forgetfulness

Geriatric Psychiatry — MCQs

Geriatric Psychiatry — MCQs

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