Old Age Psychiatry

Question 1

Macroscopic changes seen in Alzheimer’s Disease

Answer 1

Hippocampal atrophy
Cerebral atrophy
Low brain weight
Enlargement of the inferior horn of the lateral ventricle

Question 2

Microscopic changes seen in Alzheimer’s Disease

Answer 2

Senile plaques (extracellular beta amyloid in gray matter)
Neurofibrillary tangles (intracellular tau protein)
Gliosis
Degeneration of the nucleus of Meynert
Hirano bodies

Question 3

Progressive supranuclear palsy

Answer 3

Neurodegenerative disease that affects cognition, eye movements, and posture.

Vertical gaze dysfunction
Extrapyramidal symptoms
Cognitive dysfunction

Question 4

Types of fronto-temporal lobar degenerataion

Answer 4

Pick’s disease
Progressive non-fluent aphasia/CPA
Sementic dementia

Question 5

Features of fronto-temporal dementia

Answer 5

Onset before 65
Insidious onset
Relatively preserved memory and visuospatial skills
Personality change and social conduct problems

Question 6

Macroscopic features of fronto-temporal dementias

Answer 6

Atrophy of frontal and temporal lobes

Question 7

Microscopic features of fronto-temporal dementias

Answer 7

Pick bodies (tau protein)
Gliosis
Neurofibrillary tangles
Senile plaques

Question 8

Features of Pick’s disease

Answer 8

Personality change
Impaired social conduct and disinhibition
Hyperorality and increased appetite
Perseveration .

Question 9

Pathological features of Pick’s disease

Answer 9

Focal gyral atrophy with a knife-blade appearances (thin and narrow)

Question 10

Features of chronic progressive aphasia

Answer 10

Non fluent speech with short and agrammatic utterances

Comprehension is relatively preserved.

Question 11

Features of semantic dysphasia

Answer 11

Speech is fluent but empty and conveys little meaning.

Unlike in Alzheimer’s memory is better for recent rather than remote events.

Question 12

Dementia due to Parkinson’s

Answer 12

Marked problems with executive function.
Verbal and visual memory are affected to a lesser extent.
Other cognitive deficits, such as dysphasia, apraxia, alexia, agraphia, anomia and acalculia, are less pronounced.

Question 13

Features of cortical dementias

Answer 13

Impaired memory
Impaired visuospatial ability
Impaired executive function
Impaired language

Question 14

Types of cortical dementia

Answer 14

Alzheimer’s disease
Pick’s disease
Creutzfeldt-Jakob disease

Question 15

Features of sub-cortical dementias

Answer 15

Generalised slowing of mental processes
Personality change
Mood disorders
Presence of abnormal movements

Question 16

Imaging studies to differentiate Alzheimer’s, vascular dementia and FTD

Answer 16

HMPAO SPECT

FDG PET is the second choice.

Question 17

Imaging to confirm dementia with Lewy Bodies

Answer 17

(FP-CIT) SPECT (aka DaTscan)

Question 18

Risk factors for paraphrenia

Answer 18

Female
Hearing/visual impairment 
Single, no children
CVAs
Social isolation

Question 19

Risk factors for SIADH

Answer 19

Being elderly
Being female
Being a smoker
Having medical co-morbidity
Polypharmacy

Question 20

Antipsychotics recommended in delirium

Answer 20

haloperidol or olazapine

Question 21

Risk of developing Alzheimer’s disease

Answer 21

1% at age 60, doubling every 5 years to 30-50% by age 85

Question 22

Donepezil

Answer 22

Reversible acetylcholinesterase inhibitor

Question 23

Galantamine

Answer 23

Reversible acetylcholinesterase inhibitor and binds allosterically to the nicotinic acetylcholine receptor

Question 24

Rivastigmine

Answer 24

Reversible acetylcholinesterase inhibitor and butyrylcholinesterase inhibitor

Question 25

Memantine

Answer 25

NMDA receptor antagonist t

Recommended for patients intolerant of or have a contraindication to AChE inhibitors or for severe Alzheimer’s disease

Question 26

Risk factors for Charles Bonnet syndrome

Answer 26

Advanced age
Peripheral visual impairment
Social isolation
Sensory deprivation
Early cognitive impairment

Question 27

Prevalence of dementia

Answer 27

7. 1% in over 65s

1. 3% of the entire UK population.

Question 28

Breakdown of dementia severity

Answer 28

55. 4% have mild dementia
56. 1% have moderate dementia
57. 5% have severe dementia

Question 29

Antipsychotics suitable in Parkinson’s

Answer 29

Quetiapine and clozapine