Geriatric Psychiatry Practice Questions

Q: Which of the following is a cognitive disorder?

Dementia. ***Dementia*** - **Dementia** is a syndrome characterized by a significant decline in **cognitive function**, specifically in areas like memory, language, problem-solving, and reasoning. - It impairs a person's ability to perform everyday activities and is caused by various diseases that damage brain cells, such as **Alzheimer's disease**. *Intellectualization* - **Intellectualization** is an **ego defense mechanism** where a person uses excessive abstract thinking and intellectual concepts to avoid confronting emotions or internal conflicts. - While it involves thought processes, it is a psychological coping mechanism, not a cognitive disorder characterized by neurological impairment. *Depersonalization* - **Depersonalization** is a dissociative symptom characterized by a feeling of detachment from one's own body, thoughts, feelings, or actions, as if observing oneself from outside. - It's a symptom of a **dissociative disorder** or other mental health conditions, not a disorder primarily defined by cognitive impairment in the way dementia is. *All of the options* - This option is incorrect because only dementia is classified as a primary **cognitive disorder**. - Intellectualization and depersonalization are psychological phenomena or symptoms of other mental health conditions, not standalone cognitive disorders.

Q: Slow waves in EEG activity are seen in:

Delirium. **Delirium** - **Generalized slowing** of EEG activity is characteristic of **delirium**, reflecting global brain dysfunction. - This finding is often associated with **encephalopathy**, metabolic disturbances, or drug intoxication. *Depression* - EEG changes in depression are typically **less pronounced** and may involve subtle alterations in alpha rhythm, not widespread slow waves. - Depression is primarily a **mood disorder**, and while it can affect cognitive function, it does not usually cause the global cerebral dysfunction seen in delirium. *Schizophrenia* - EEG findings in schizophrenia are often **non-specific** or involve subtle changes like increased theta activity, but not generalized slow waves. - Schizophrenia is a **psychotic disorder** characterized by thought disturbances, which are not reflected as global EEG slowing. *Mania* - Acute manic episodes are generally associated with **normal EEG activity**, or sometimes increased fast activity. - Mania is a **mood disorder** characterized by elevated energy and mood, distinct from the global cognitive impairment of delirium.

Q: Global cerebral dysfunction characterised by alteration in cognitive function and consciousness is known as

Delirium. ***Delirium*** - Delirium is characterized by an **acute onset** of global cerebral dysfunction, marked by fluctuations in **attention, consciousness, and cognition**. - It is a medical emergency that can be caused by various underlying medical conditions, medications, or substance withdrawal. *Dementia* - Dementia is a **chronic** and progressive decline in cognitive function, primarily affecting **memory, language, and problem-solving abilities**, without a primary disturbance of consciousness. - While it involves cognitive impairment, its onset is typically gradual, and it lacks the acute fluctuations and prominent consciousness alterations seen in delirium. *Depression* - Depression is a **mood disorder** characterized by persistent sadness, loss of interest, and other emotional and physical symptoms, which can affect concentration and memory. - It does not involve a primary alteration in consciousness or the acute, global cognitive dysfunction characteristic of delirium. *Acute anxiety* - Acute anxiety is a state of intense fear or uneasiness, often accompanied by physical symptoms like palpitations and shortness of breath. - While it can interfere with focus and concentration, it does not represent a global cerebral dysfunction or an alteration in consciousness in the way that delirium does.

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: Which of the following feature differentiates delirium from dementia?

Acute confusional state. ***Acute confusional state*** - Delirium is characterized by an **acute or subacute onset** of fluctuating attention and cognition, indicating a sudden and often reversible change in mental status. - This contrasts sharply with dementia, which typically involves a **gradual and progressive decline** over months to years. *Progressive memory impairment* - This is a hallmark feature of **dementia**, where memory loss gradually worsens over time as the disease progresses. - While memory can be impaired in delirium, its onset is acute and severe memory impairment typically only occurs in cases of **severe delirium**, not as a primary defining feature. *Visual or auditory hallucinations* - While hallucinations can occur in both delirium and dementia, they are more **prominent and vivid** in delirium, often fluctuating and contributing to the acute confusional state. - In dementia, hallucinations are usually less frequent and tend to be **more persistent**, but not typically as variable as in delirium. *Impaired communication due to cognitive decline* - Both conditions can cause difficulty with communication due to cognitive deficits, but in dementia, this impairment is **gradual and pervasive**, reflecting a chronic decline in language and executive function. - In delirium, communication difficulties arise from the **acute disturbance of attention** and can fluctuate significantly depending on the patient's level of arousal and confusion.

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: Clouding of consciousness is seen in:

Delirium. ***Delirium*** - **Clouding of consciousness**, characterized by reduced clarity of awareness, is a hallmark feature of delirium. - Patients with delirium often experience a fluctuating level of consciousness, disorientation, and impaired attention. *Schizophrenia* - Schizophrenia primarily involves disturbances in **thought processes**, perception, and emotion, such as hallucinations and delusions. - While cognitive deficits may be present, clouding of consciousness in the acute sense is not a primary diagnostic criterion. *Dementia* - Dementia is characterized by a **gradual decline** in cognitive function, including memory, judgment, and language. - Consciousness typically remains clear in dementia, distinguishing it from delirium where consciousness is impaired. *Depression* - Depression is a **mood disorder** with symptoms such as persistent sadness, loss of interest, and changes in sleep or appetite. - While severe depression can lead to psychomotor retardation or cognitive slowing, it does not typically involve the clouding of consciousness seen in delirium.

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 is a cognitive disorder?

Accepted Answer

Dementia

Answer

Intellectualization

Answer

Depersonalization

Answer

All of the options

Question 2

Slow waves in EEG activity are seen in:

Accepted Answer

Delirium

Answer

Depression

Answer

Schizophrenia

Answer

Mania

Question 3

Global cerebral dysfunction characterised by alteration in cognitive function and consciousness is known as

Accepted Answer

Delirium

Answer

Dementia

Answer

Depression

Answer

Acute anxiety

Question 4

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 5

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 6

Which of the following feature differentiates delirium from dementia?

Accepted Answer

Acute confusional state

Answer

Progressive memory impairment

Answer

Visual or auditory hallucinations

Answer

Impaired communication due to cognitive decline

Question 7

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 8

Clouding of consciousness is seen in:

Accepted Answer

Delirium

Answer

Schizophrenia

Answer

Dementia

Answer

Depression

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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