Geriatric Psychiatry Practice Questions

Q: Dementia is seen in all except -

Schizophrenia. ***Schizophrenia*** - Schizophrenia is primarily a **psychotic disorder** characterized by delusions, hallucinations, disorganized thinking, and negative symptoms. While cognitive deficits are common, they typically involve executive functions, attention, and memory, rather than the widespread and progressive decline in multiple cognitive domains seen in **dementia**. - Although individuals with schizophrenia may experience significant cognitive impairment, it rarely leads to the profound and globally incapacitating cognitive decline that defines dementia. *Huntington's chorea* - Huntington's chorea is a **neurodegenerative disorder** that invariably leads to dementia, typically presenting as a subcortical dementia with prominent **executive dysfunction** and behavioral changes. - The cognitive decline is a hallmark feature alongside the characteristic **chorea** (involuntary movements). *Pick's ds.* - Pick's disease, now known as **frontotemporal dementia (FTD)-behavioral variant**, is a form of dementia specifically affecting the frontal and temporal lobes. - It is characterized by early and prominent changes in **personality, behavior, and language**, preceding significant memory impairment. *Alzheimer's disease* - Alzheimer's disease is the most common cause of dementia, characterized by progressive and severe impairments in **memory, judgment, language, and other cognitive functions**. - The accumulation of **amyloid plaques** and **neurofibrillary tangles** is the pathological hallmark of the disease.

Q: All of the following are features of dementia, EXCEPT:

Clouding of consciousness present. ***Clouding of consciousness present*** - **Clouding of consciousness** is a hallmark feature of **delirium**, not dementia. Delirium is characterized by an acute, fluctuating disturbance of attention and cognition. - In dementia, consciousness typically remains clear until the very late stages of the disease, even as cognitive functions decline significantly. *Insidious in onset* - Dementia typically has an **insidious onset**, meaning symptoms develop gradually over months or years, often unnoticed initially by the patient or family. - This contrasts with the sudden or acute onset often seen in conditions like delirium or stroke. *Visual hallucinations may occur* - **Visual hallucinations** can occur in various forms of dementia, particularly in **dementia with Lewy bodies** and Parkinson's disease dementia. - While not universally present, their occurrence is a recognized potential feature of the disease. *Usually irreversible* - Most types of dementia, including **Alzheimer's disease**, **vascular dementia**, and **dementia with Lewy bodies**, are progressive and **irreversible**. - There are some treatable causes of cognitive impairment that can mimic dementia, but true dementia conditions generally do not resolve.

Q: The following are the psychiatric sequelae after stroke in the elderly: a) Depression b) Post-traumatic stress disorder c) Dementia d) Hysteria

ac. ***ac (Depression + Dementia)*** Post-stroke psychiatric sequelae in the elderly primarily include: **a) Depression** - ✓ CORRECT - Post-stroke depression affects 30-50% of stroke survivors - Results from both neurobiological changes (disruption of monoaminergic pathways) and psychological reaction to disability - Significantly impacts rehabilitation and recovery outcomes - Recognized as the most common psychiatric complication after stroke **c) Dementia** - ✓ CORRECT - Vascular dementia is a well-established consequence of stroke - Risk of dementia doubles after stroke - Cognitive impairment occurs in 20-30% of post-stroke patients - Can result from strategic single infarcts or cumulative vascular damage *b) Post-traumatic stress disorder* - INCORRECT - While PTSD can occasionally occur after severe strokes with traumatic ICU experiences, it is NOT a common or primary psychiatric sequela - Incidence is low compared to depression and cognitive impairment - Not considered a typical post-stroke psychiatric complication *d) Hysteria* - INCORRECT - "Hysteria" is an outdated term no longer used in modern psychiatric classification - NOT a recognized psychiatric sequela of stroke in the elderly - Conversion disorders are rare after stroke and have different etiology

Q: Reversible dementia is seen in all EXCEPT:

Alzheimer's. ***Alzheimer's*** - Alzheimer's disease is a **progressive neurodegenerative disorder** characterized by the accumulation of **beta-amyloid plaques** and **neurofibrillary tangles**, leading to irreversible cognitive decline. - While symptoms can be managed, the underlying pathology of Alzheimer's is **irreversible** and gets progressively worse. *Hypothyroidism* - **Severe or untreated hypothyroidism** can lead to cognitive impairment resembling dementia, often referred to as "myxedema madness." - This cognitive dysfunction is typically **reversible** with appropriate **thyroid hormone replacement therapy**. *Wernicke's encephalopathy* - This condition is caused by a **thiamine (vitamin B1) deficiency**, commonly seen in chronic alcoholics. - The cognitive deficits, including confusion and memory problems, are **reversible** if treated promptly with **thiamine supplementation**. *Head trauma* - **Acute cognitive deficits** following mild to moderate traumatic brain injury (TBI) can be **reversible** with rehabilitation and recovery time. - However, it's important to note that **severe TBI** and **chronic traumatic encephalopathy (CTE)** typically cause **irreversible** dementia. - In the context of this question, head trauma is generally classified under reversible causes when referring to **acute post-traumatic cognitive impairment** that can improve with treatment.

Q: Alzheimer's disease is associated with:

Dementia. ***Dementia*** - **Alzheimer's disease** is the most common cause of **dementia**, a chronic and progressive neurodegenerative disorder characterized by a decline in cognitive function. - Key features include **memory loss**, particularly of recent events, along with impairments in language, problem-solving, and other cognitive abilities that interfere with daily life. *Delusion* - **Delusions** are fixed, false beliefs that are not amenable to change in light of conflicting evidence, more commonly associated with **psychotic disorders** like **schizophrenia**. - While individuals with advanced Alzheimer's disease can experience neuropsychiatric symptoms, including delusions, they are not the primary or defining feature of the disease itself. *Parkinsonism* - **Parkinsonism** refers to a group of neurological disorders characterized by motor symptoms such as **tremor**, **bradykinesia**, **rigidity**, and **postural instability**. - It is the hallmark of diseases like **Parkinson's disease** or **Lewy body dementia**, but not the primary feature of Alzheimer's disease, although some individuals with Alzheimer's may later develop parkinsonian features. *Delirium* - **Delirium** is an acute, fluctuating confusional state characterized by a disturbance in attention and awareness. - It is typically caused by an underlying medical condition, medication, or substance withdrawal, and is often reversible, unlike the chronic and progressive nature of Alzheimer's dementia.

Q: Risk factors for Alzheimer's include:-

Down's syndrome. ***Down's syndrome*** - Individuals with **Down's syndrome** have an extra copy of chromosome 21, which includes the **amyloid precursor protein (APP) gene**. - Overexpression of APP leads to increased production of **beta-amyloid plaques**, a hallmark pathology of Alzheimer's disease. *Parkinson's disease* - Parkinson's disease is a **neurodegenerative disorder** characterized by motor symptoms due to loss of dopaminergic neurons. - While it can be associated with **dementia (Parkinson's disease dementia)**, it is a distinct condition with different primary pathological mechanisms (alpha-synucleinopathy). *Vascular dementia* - **Vascular dementia** is caused by brain damage from conditions that impair blood flow to the brain, such as strokes or small vessel disease. - It is a **different type of dementia** with distinct etiology and neuropathology compared to Alzheimer's disease. *Huntington's disease* - **Huntington's disease** is a genetic neurodegenerative disorder characterized by involuntary movements (**chorea**), cognitive decline, and psychiatric problems. - It is caused by a mutation in the **Huntingtin gene** and has a specific pathological course unrelated to Alzheimer's.

Q: Which of the following is NOT true about delirium?

It has a slow, insidious onset. ***It has a slow, insidious onset*** - Delirium is characterized by an **acute** or **subacute** onset, meaning it develops rapidly over hours to days, not slowly and insidiously. - An insidious onset is more characteristic of **dementia**, which differs significantly from delirium in its course. *Characterized by fluctuating consciousness* - **Fluctuating consciousness** is a hallmark feature of delirium, where the level of awareness and cognitive function can change significantly throughout the day. - Patients with delirium often exhibit periods of **lucidity** interspersed with confusion and disorientation. *Reversible with treatment* - Delirium is often **reversible** if the underlying causes, such as infection, metabolic imbalances, or medication side effects, are identified and treated promptly. - This distinguishes it from **dementia**, which is generally a progressive and irreversible condition. *Common in elderly patients* - Delirium is indeed very **common in elderly patients**, particularly those with pre-existing cognitive impairment, multiple comorbidities, or those in critical care settings. - Their physiological vulnerability makes them more susceptible to the stressors that can precipitate delirium.

Q: Which of the following is the most prominent clinical characteristic of Alzheimer's disease?

Memory loss. ***Memory loss*** - **Memory loss**, particularly of recent events (anterograde amnesia), is the **earliest and most prominent clinical symptom** of Alzheimer's disease. - This is a **clinical characteristic** - an observable symptom experienced by the patient and noted by clinicians during evaluation. - The memory deficit progressively worsens, initially affecting **short-term recall** and learned information, eventually extending to long-term memory and significantly impacting daily functioning. *Neurofibrillary tangles* - **Neurofibrillary tangles**, composed of hyperphosphorylated tau protein, are a **pathological hallmark** found in the brains of Alzheimer's patients at autopsy or biopsy. - These are **microscopic findings**, not a clinical characteristic - they cannot be observed directly by the patient or clinician during clinical evaluation. - Essential for definitive neuropathological diagnosis but not a clinical symptom. *Amyloid plaques* - **Amyloid plaques** (senile plaques), formed by aggregation of beta-amyloid peptides, are another **pathological hallmark** of Alzheimer's disease. - Like neurofibrillary tangles, these are **microscopic neuropathological findings**, not observable clinical symptoms. - They represent the underlying disease pathology but not the clinical presentation. *Resting tremor* - A **resting tremor** is a cardinal motor symptom of **Parkinson's disease**, not Alzheimer's disease. - While some patients with advanced Alzheimer's may develop motor symptoms, resting tremor is **not a characteristic or prominent feature** of Alzheimer's disease. - This option tests knowledge of differential diagnosis between neurodegenerative disorders.

Q: A 70-year-old female with Alzheimer's disease presents with increased confusion and agitation. What is the most appropriate management?

Increase donepezil dose. ***Increase donepezil dose*** - In patients with Alzheimer's disease who develop **new or worsening neuropsychiatric symptoms** like confusion and agitation, increasing the dose of a **cholinesterase inhibitor** like donepezil can be beneficial. - This approach aims to reduce behavioral symptoms by improving **cholinergic transmission** without the significant side effects associated with antipsychotics in this vulnerable population. - Optimizing cholinesterase inhibitor therapy should be attempted before adding other medications. *Start an antipsychotic* - Antipsychotics carry a **black box warning** for increased mortality in elderly patients with dementia-related psychosis, especially those with **cardiovascular disease** or **cerebrovascular disease**. - They should generally be reserved as a **last resort** for severe, refractory agitation or psychosis when non-pharmacological and other pharmacological interventions have failed. - Risk of extrapyramidal symptoms, falls, and cognitive worsening. *Add a benzodiazepine* - Benzodiazepines can worsen **cognitive impairment**, increase the risk of **falls**, and potentially exacerbate **agitation** or confusion in elderly patients with dementia. - Their use should be strictly limited to short-term management of acute, severe agitation due to the risk of **paradoxical reactions** and dependence. - Particularly problematic in dementia due to cognitive side effects. *Start memantine* - Memantine is an **NMDA receptor antagonist** indicated for moderate to severe Alzheimer's disease to improve cognition and function. - While it can help manage some behavioral symptoms, it is typically added as **combination therapy** rather than as first-line adjustment when a patient is already on a cholinesterase inhibitor. - Optimizing existing therapy (increasing donepezil) is more appropriate before adding another agent.

Q: A 68-year-old male diagnosed with Lewy Body Dementia. Which neurotransmitter system is primarily affected?

Dopaminergic. **Dopaminergic** - The **dopaminergic system** is the **primary and most severely affected** neurotransmitter system in **Lewy Body Dementia (LBD)** due to the accumulation of **alpha-synuclein** Lewy bodies in dopaminergic neurons, particularly in the **substantia nigra**. - This leads to the characteristic **parkinsonian motor symptoms** such as **bradykinesia**, **rigidity**, and **tremor**, which are often prominent early in LBD. - **Note:** The **cholinergic system** is also significantly affected in LBD (even more than in Alzheimer's disease), which is why **cholinesterase inhibitors** are first-line treatment, but the dopaminergic deficit is considered primary. *Serotonergic* - While there can be some **serotonergic involvement** in LBD, it is not the primary or most significantly affected neurotransmitter system. - Dysregulation in serotonin pathways is more typically associated with mood disorders like **depression** and some aspects of **anxiety disorders**. *GABAergic* - The **GABAergic system** is not the primary target of neurodegeneration in LBD. GABA (gamma-aminobutyric acid) is the main **inhibitory neurotransmitter** in the brain. - Disruptions in GABAergic signaling are more commonly linked to conditions like **epilepsy** and **anxiety disorders**. *Glutamatergic* - **Glutamatergic dysfunction** can occur in various neurodegenerative diseases, including Alzheimer's disease, but it is not considered the primary neurotransmitter system affected in LBD. - Glutamate is the main **excitatory neurotransmitter**, and its dysregulation is often implicated in **excitotoxicity** and cognitive decline in various dementias.

Question 1

Dementia is seen in all except -

Accepted Answer

Schizophrenia

Answer

Huntington's chorea

Answer

Pick's disease

Answer

Alzheimer's disease

Question 2

All of the following are features of dementia, EXCEPT:

Accepted Answer

Clouding of consciousness present

Answer

Insidious in onset

Answer

Visual hallucinations may occur

Answer

Usually irreversible

Question 3

The following are the psychiatric sequelae after stroke in the elderly: a) Depression b) Post-traumatic stress disorder c) Dementia d) Hysteria

Accepted Answer

ac

Answer

bc

Answer

a

Answer

b

Question 4

Reversible dementia is seen in all EXCEPT:

Accepted Answer

Alzheimer's

Answer

Hypothyroidism

Answer

Wernicke's encephalopathy

Answer

Head trauma

Question 5

Alzheimer's disease is associated with:

Accepted Answer

Dementia

Answer

Delusion

Answer

Parkinsonism

Answer

Delirium

Question 6

Risk factors for Alzheimer's include:-

Accepted Answer

Down's syndrome

Answer

Parkinson's disease

Answer

Vascular dementia

Answer

Huntington's disease

Question 7

Which of the following is NOT true about delirium?

Accepted Answer

It has a slow, insidious onset

Answer

Characterized by fluctuating consciousness

Answer

Reversible with treatment

Answer

Common in elderly patients

Question 8

Which of the following is the most prominent clinical characteristic of Alzheimer's disease?

Accepted Answer

Memory loss

Answer

Neurofibrillary tangles

Answer

Amyloid plaques

Answer

Resting tremor

Question 9

A 70-year-old female with Alzheimer's disease presents with increased confusion and agitation. What is the most appropriate management?

Accepted Answer

Increase donepezil dose

Answer

Add a benzodiazepine

Answer

Start memantine

Answer

Start an antipsychotic

Question 10

A 68-year-old male diagnosed with Lewy Body Dementia. Which neurotransmitter system is primarily affected?

Accepted Answer

Dopaminergic

Answer

Serotonergic

Answer

GABAergic

Answer

Glutamatergic

Geriatric Psychiatry — MCQs

Geriatric Psychiatry — MCQs

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