Geriatric Psychiatry — MCQs
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Which of the following dementia is associated with visual hallucinations?
True about delirium is all Except:
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?
Dementia is present in all except:
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:
Dementia of Alzheimer's type is not associated with one of the following
All are true about dementia except:
Regarding Alzheimer's disease which is/are not true :
All are true regarding Fronto-temporal dementia except:
Not a feature of dementia is -
Geriatric Psychiatry Indian Medical PG Practice Questions and MCQs
Question 31: Which of the following dementia is associated with visual hallucinations?
- A. Lewy body dementia (Correct Answer)
- B. AIDS related Dementia
- C. Mixed dementia
- D. Huntington's disease
Explanation: ***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.
Question 32: True about delirium is all Except:
- A. Preserved attention (Correct Answer)
- B. Hallucination
- C. Disturbed sleep
- D. Disorientation
Explanation: ***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.
Question 33: 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?
- A. Dissociative amnesia
- B. Schizophrenia
- C. Alzheimer's disease (Correct Answer)
- D. Psychotic disorder
Explanation: ***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.
Question 34: Dementia is present in all except:
- A. Lewy body dementia
- B. Pick's disease
- C. Ganser syndrome (Correct Answer)
- D. Alzheimer's disease
Explanation: ***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.
Question 35: 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:
- A. Schizophrenia
- B. Dementia (Correct Answer)
- C. Depression
- D. Mania
Explanation: ***Dementia*** - The patient presents with **progressive cognitive decline** (forgetfulness, personality decline, poor self-care), **visual hallucinations**, and a **low MMSE score (21)**, all highly indicative of dementia. - The **visual hallucinations** in the context of progressive cognitive decline are particularly suggestive of **Dementia with Lewy Bodies (DLB)**, where visual hallucinations are a core diagnostic feature. - The **insidious onset** and **progressive deterioration** over one year with prominent behavioral and cognitive symptoms rule out acute or remitting conditions and fit the profile of a neurodegenerative dementia. - **MMSE score of 21** indicates mild-to-moderate cognitive impairment, consistent with dementia. *Schizophrenia* - While schizophrenia involves hallucinations and personality changes, the primary feature is usually **psychosis with delusions and auditory hallucinations**, not visual hallucinations. - Schizophrenia typically has an **earlier onset** (young adulthood) and does not present with **progressive memory decline and cognitive deterioration** as the dominant feature. - The **age of onset (65 years)** and **prominent cognitive decline** make late-onset schizophrenia very unlikely. *Depression* - Depression can cause cognitive symptoms (**pseudodementia**), but these are usually **reversible** and associated with prominent **mood disturbances** (sadness, anhedonia, hopelessness). - In pseudodementia, patients often **complain** about memory problems, whereas in true dementia, patients may be **unaware** or minimize deficits. - The presence of **visual hallucinations** and **sustained personality decline over one year** without mention of mood symptoms makes primary depression unlikely. *Mania* - Mania is characterized by **elevated or irritable mood**, **increased energy**, **racing thoughts**, **decreased need for sleep**, and **impulsive behavior**, none of which are described in this patient. - Cognitive disturbances in mania are **episodic** and associated with mood elevation, not characterized by **progressive, year-long decline** in memory and self-care.
Question 36: Dementia of Alzheimer's type is not associated with one of the following
- A. Delusions
- B. Apraxia and aphasia
- C. Cerebral infarcts (Correct Answer)
- D. Depressive symptoms
Explanation: ***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.
Question 37: All are true about dementia except:
- A. Loss of long term memory
- B. Impaired learning
- C. Always reversible with medication (Correct Answer)
- D. Loss of short term memory
Explanation: ***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.
Question 38: Regarding Alzheimer's disease which is/are not true :
- A. Initial loss of long term memory
- B. Step ladder pattern
- C. Delayed loss of short term memory
- D. All of the options (Correct Answer)
Explanation: ***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.
Question 39: All are true regarding Fronto-temporal dementia except:
- A. Affective symptoms
- B. Age less than 65 years
- C. Insight present (Correct Answer)
- D. Stereotypic behavior
Explanation: ***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.
Question 40: Not a feature of dementia is -
- A. Loss of neurons in brain matter
- B. Loss of sensorium (Correct Answer)
- C. Wearing of dirty clothes
- D. Forgetfulness
Explanation: ***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.
Practice by Chapter
Normal Aging Process
Practice Questions
Dementia: Alzheimer's Type
Practice Questions
Other Neurocognitive Disorders
Practice Questions
Delirium in the Elderly
Practice Questions
Late-Life Depression
Practice Questions
Anxiety Disorders in the Elderly
Practice Questions
Psychosis in the Elderly
Practice Questions
Sleep Disorders in the Elderly
Practice Questions
Pharmacotherapy Considerations in the Elderly
Practice Questions
Elder Abuse and Neglect
Practice Questions
End-of-Life Issues
Practice Questions
Long-term Care Issues
Practice Questions
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