Geriatric

Question 1

There are a number of genetic syndromes that are linked with premature aging. Although all of these are quite rare, one is characterized by dwarfism, physical immaturity, pseudosenility, and hypermetabolism. The affected individuals usually die in their mid-teens of coronary heart disease. What is this disorder?

Answer 1

Hutchinson-Gilford syndrome.

Question 2

How did women’s life expectancy change in the 20th century?

Answer 2

The life expectancy in the United States for women has increased from 48.3 years in 1900 to 80.4 years in 2004.

Question 3

One of the landmark studies of the prevalence of psychiatric disorders in the United States was the Epidemiologic Catchment Area (ECA) survey. What was discovered about people 65 and older?

Answer 3

Of those age 65 or older, 12.3% (13.6% of the women and 10.5% of the men) met criteria for one or more psychiatric disorders in the month prior to the interview. The two most prevalent disorders in this age group were any anxiety disorder (5.5%) and severe cognitive impairment (4.9%) (Regier et al. 1988).

Question 4

What has been the focus of genetic research in Alzheimer’s?

Answer 4

Genetic research in Alzheimer’s disease and dementia has focused on the epsilon 4 allele of the APOE gene (Evans et al. 1997; A.M. Saunders et al. 1993).

Question 5

Acetylcholine (ACh) acts through a family of muscarinic ACh receptors. Which muscarinic (M) receptor is the most abundant receptor in the neocortex and hippocampus tissue?

Answer 5

M1

Question 6

Which of the primary mental abilities declines last with aging but also shows a steeper decline than other abilities from the 70s to the 80s?

Answer 6

Verbal meaning declines last but also shows steeper decline than the other abilities from the 70s to the 80s (Schaie 2005, p. 116).

Question 7

At what age will the average older adult’s primary mental abilities fall below the middle range of performance for young adults?

Answer 7

80s (Seattle Longitudinal Study)

Question 8

Three studies have examined the predictors of the number of days of survival beyond 100 years. What was a common variable in all three studies that predicted longer survival?

Answer 8

Cognitive status.

Question 9

What personality changes have been documented across the lifespan?

Answer 9

A number of studies have pointed out that neuroticism appears to decline with age (Mroczek and Spiro 2003; Small et al. 2003) and that agreeableness and conscientiousness appear to increase over time (Helson et al. 2002; Small et al. 2003).

Question 10

A patient asks you whether there are certain personality traits that may predict shorter life spans or premature mortality. What are such personality characteristics?

Answer 10

hostility and pessimism (Siegler 2007) (Brummett et al. 2006).

Question 11

A consensual model of the precursors of psychiatric disorders has emerged from the social science and social psychiatry literature. The model is composed of a series of stages. Describe stage 1.

Answer 11

The first stage consists of demographic variables that are associated with the risk of psychiatric disor-ders. Virtually all studies of social factors and psychiatric disorders include demographic factors, especially age, race/ethnicity, and sex.

Question 12

A consensual model of the precursors of psychiatric disorders has emerged from the social science and social psychiatry literature. The model is composed of a series of stages. Describe stage 2.

Answer 12

Stage II consists of relatively early experiences that are hypothesized to have persistent effects on an individual’s vulnerability to psychiatric disorders. Examples of such experiences include childhood traumas (e.g., the early death or marital disruption of parents) and educational attainment.

Question 13

A consensual model of the precursors of psychiatric disorders has emerged from the social science and social psychiatry literature. The model is composed of a series of stages. Describe stage 3.

Answer 13

Stage III consists of later events and experiences, including family relationships and economic achievements.

Question 14

A consensual model of the precursors of psychiatric disorders has emerged from the social science and social psychiatry literature. The model is composed of a series of stages. Describe stage 4.

Answer 14

Stage IV consists of dimensions of social integration. Social integration occurs at two levels. At the individual level, social integration refers to personal attachments to formal aspects of the social structure (religious affiliation and participation in organizations are two examples). At the aggregate level, social integration refers to the extent to which a collectivity (e.g., a city, a country) is characterized by meaningful ties and a sense of collective identity among residents.

Question 15

Describe the major dimensions of social support.

Answer 15

1) social network—the size and structure of the network of people available to provide support
2) instrumental support—the specific tangible services provided by families and friends
3) perceptions of social support—subjective evaluations of satisfaction with the available support.
4) tolerance by the family of specific behaviors that derive from the psychiatric disorder.

Question 16

In gathering information from elderly patients concerning their present illness, you should assess their function and change in function. Two important parameters for this type of assessment are not normally included in the assessment of physical and psychiatric illness in younger adults. One of these parameters is social functioning. What is the other?

Answer 16

Activities of daily living.

Question 17

A number of rating scales have been used to screen for depression in seniors. Which is an interviewer-rated scale that does not include many of the somatic symptoms that tend to be more common in older adults?

Answer 17

Montgomery-Åsberg Rating Scale for Depression.

Question 18

You are treating an 83-year-old patient for depression and she develops fatigue, nausea, dizziness, gait disturbances, forgetfulness, confusion, lethargy, and muscle cramps. You obtain a general chemistry panel, and her serum sodium concentration is 120 mEq/L. What psychotropic medication has been reported to produce this condition in the elderly?

Answer 18

Selective serotonin reuptake inhibitors.

Question 19

In a community psychiatry clinic, you see for the first time a 78-year-old patient who has been treated for a number of years with thioridazine. You immediately decide to order an electrocardiogram (ECG). What ECG changes are you particularly concerned about?

Answer 19

QTc prolongation

Question 20

In the early stages of Alzheimer’s disease, the medial temporal lobe is most affected, leading to impairment of which of the following cognitive processes?

Answer 20

recent memory processing

Question 21

Age-related cognitive changes are manifested in the decline in a number of tasks or abilities. What are some examples?

Answer 21

A. Motor responses.
B. Reaction times.
C. Fluid abilities.
D. Retrieval functions.

Question 22

Which of the dementias is characterized by early fluctuations in cognition and attention, recurrent and persistent visual hallucinations, and extrapyramidal motor symptoms?

Answer 22

Dementia with Lewy bodies (DLB).

Question 23

Which of the dementias is characterized by prominent early changes in behavior, personality, or language, as opposed to impairments in memory and other aspects of cognition?

Answer 23

Frontotemporal lobar dementia.

Question 24

PDD (Parkinson) and DLB (Lewy Body) may be distinguished from Alzheimer’s disease by which symptoms that normally occur early on in both PDD and DLB?

Answer 24

Visual spatial disturbances

Question 25

Several neurotransmitters have been implicated in the mechanism of delirium. The most frequently considered neurotransmitter for which there is the most evidence is

Answer 25

Acetylcholine.

Question 26

What is the leading risk factor for development of delirium?

Answer 26

Dementia.

Question 27

A validated model for prediction of persistent delirium in hospitalized older patients at discharge has identified five risk factors. What are they?

Answer 27

dementia, vision impairment, functional impairment, high comorbidity, and use of physical restraints during delirium (Inouye et al. 2007)

Question 28

What are the four characteristics of the “cortical” subsyndrome of dementia?

Answer 28

The cortical subsyndrome is characterized by the four A’s of impairment (amnesia, apraxia, aphasia, agnosia)

Question 29

What are the four characteristics of the “subcortical” subsyndrome of dementia?

Answer 29

the four D’s (dysmnesia, delay, dysexecutive symptoms, depletion)

Question 30

Which of the dementia syndromes is the second most common form of dementia in persons under age 65, with a rate of occurrence that is close to that of Alzheimer’s disease?

Answer 30

Frontotemporal degeneration (FTD).

Question 31

Which of the movement disorders produces myoclonic, apraxic, rigid, akinetic movements and alien hand syndrome, in which one hand seems to have a mind of its own?

Answer 31

Cortical-basal ganglionic degeneration (CBGD).

Question 32

What is a progressive, neurodegenerative condition consisting of parkinsonism without prominent tremor, vertical gaze palsy, ax-ial (midline) more than appendicular (arm and leg) rigidity, early postural instability, and poor response to levodopa?

Answer 32

Progressive supranuclear palsy (PSP), or Steele-Richardson-Olszewski syndrome

Question 33

What are factors associated with improved outcomes in late-life depression?

Answer 33

a history of recovery from previous episodes, a family history of depression, female gender, extraverted personality, current or recent employment, absence of substance abuse, no history of major psychiatric disorder, less severe depressive symptomatology, and absence of major life events and serious medical illness (Baldwin and Jolley 1986; Cole et al. 1999; Post 1972).

Question 34

Adults are thought to acquire increased wisdom as they age. One group of investigators has operationalized wisdom and studied it in community samples. What factors are associated with increased wisdom?

Answer 34

Five criteria can be used to assess wisdom: rich factual knowledge; rich procedural knowledge (e.g., the ability to develop strategies for addressing problems); life span contextualization (e.g., integrating life experiences); relativism of values and life priorities (e.g., tolerance for differences in society); and recognition and management of uncertainty (accepting that the future cannot be known with certainty and that the ability to assess one’s sociocultural environment is inherently constrained). (Baltes and Staudinger 2000).