Deck 13: Aging and Neurocognitive Disorders

Question 1

Which statement is True concerning the development of bipolar disorder among older adults?

A) The late-life development of bipolar disorder is relatively common.
B) When bipolar disorder develops late in life, there is usually no history of major depression or mania earlier in life.
C) Medical rather than genetic factors are usually associated with the late-life onset of bipolar disorder.
D) When bipolar disorder develops late in life, the intervals between the manic and depressive episodes tend to be fairly long.

Answer 1

Medical rather than genetic factors are usually associated with the late-life onset of bipolar disorder.

Question 2

A mood disorder that occurs in the context of cerebrovascular disease is known as

A) vascular depression.
B) Alzheimer's disease.
C) vascular dementia.
D) pseudodementia.

Answer 2

vascular depression.

Question 3

Medical problems are more common as people age. What issue does this raise for physicians and therapists who care for aging patients?

A) Medical ailments must be cured before psychological difficulties can be assessed.
B) Many medical diseases and treatments create symptoms that mimic psychological disorders.
C) Psychological disorders, unless very severe, are less significant for patients than medical problems.
D) Treating medical problems often leaves patients with no funds for therapy.

Answer 3

Many medical diseases and treatments create symptoms that mimic psychological disorders.

Question 4

____________ is the tendency to attribute a multitude of problems to advancing age.

A) Adultism
B) Ageism
C) Geropsychology
D) Chronocentrism

Question 5

According to the text, which two psychological disorders are most common among older adults?

A) Phobias and PTSD
B) Substance abuse and PTSD
C) Depression and anxiety
D) Dementia and psychosis

Question 6

Depression among older people often includes cognitive difficulties such as problems with attention, speed of information processing, and ___________________.

A) Executive dysfunction
B) Reversible dementia
C) Vascular depression
D) Substance/medication-induced major or minor neurocognitive disorder.

Question 7

Compared with younger adults, older adults typically report a

A) greater degree of negative mood and more focus on psychological symptoms.
B) lesser degree of negative mood and more focus on psychological symptoms.
C) greater degree of negative mood and more focus on physical symptoms.
D) lesser degree of negative mood and more focus on physical symptoms.

Question 8

Lily is a 71-year-old woman who recently suffered a minor stroke with no permanent physical or cognitive impairments. Within a week after the stroke, Lily who is normally an outgoing and energetic person, started to withdraw from family and friends and lost interest in most of her hobbies. Her movements became extremely sluggish. Lily's family finally insisted that she see her doctor when it became increasingly difficult for her to name objects/people and her speech became less fluent. Given this information, Lily may be suffering from

A) pseudodementia.
B) vascular depression.
C) vascular dementia.
D) multi-infarct dementia.

Question 9

Although few adults develop bipolar disorder after the age of 65, when it does occur, the intervals between manic and depressive periods are __________ and the episodes are____________ than in younger adults.

A) longer; shorter
B) shorter; shorter
C) longer; longer
D) shorter; longer

Question 10

Regarding the relationship between depression and race/ethnicity among the Canadian elderly, research shows:

A) little is known.
B) it is an area of immense focus.
C) Men have higher prevalence rates than do women.
D) Caucasian men suffer from depression more than immigrants.

Question 11

____________ focuses on the unique challenges (e.g., physical changes, lifestyle shifts, and role changes) and psychological symptoms faced by older adults.

A) Geriatrics
B) Geriatric neuroscience
C) Geriatric psychiatry
D) Geropsychology

Question 12

As compared to the suicide rate among young adults with depression, the suicide rate among depressed older adults:

A) lower.
B) about the same.
C) slightly higher.
D) executive much higher.

Question 13

Although there is not yet a consistent definition of the term "successful aging," researchers have identified several common themes, including

A) higher level of education, financial security, and limited caregiver role.
B) presence of a spouse/significant other, socioeconomic status, and spirituality.
C) absence of cognitive impairments, perceived good health and an active lifestyle, and positive social relationships.
D) higher level of education, spirituality, and positive social relationships.

Question 14

In Canada, about 20% of people ages 65 years and older have a psychological disorder. Approximately _____% of these individuals receive treatment.

A) 10; 35
B) 10; 50
C) 12; 35
D) 20; 50

Question 15

Reasons why older adults do not seek mental health treatment include

A) family members do not feel it is necessary, a preference for medical professionals over mental health professionals, and insurance will not cover psychiatric services.
B) distrust of the mental health profession, chronic illnesses and physical disabilities, and lack of encouragement from medical professionals.
C) others will think they are "crazy," lack of sufficient resources, and inability to drive to the clinician's office.
D) increased caregiver responsibilities, family members do not feel it is necessary, and distrust of the mental health profession.

Question 16

As is True of younger adults, depressive disorders among older people occur more often in _____________.

A) men than in women.
B) women than in men.
C) there is no difference.
D) Older people rarely suffer from depression.

Question 17

In the general population of older adults, prevalence rates for depressive disorders are between

A) 4% and 10%.
B) 5% and 11%.
C) 10% and 14%.
D) 15% and 19%.

Question 18

A theoretical model that suggests that people age more successfully when they modify their goals and choices to make best use of their personal characteristics is known as selective

A) optimization and compensation.
B) modification and compensation.
C) optimization and modification.
D) modification and redefinition.

Question 19

Older adults who DO seek out mental health treatment usually go to

A) their primary care physician.
B) mental health professionals.
C) community outreach programs.
D) religious organizations or spiritual advisors.

Question 20

Alzheimer's patients are diagnosed with depression when the symptoms of the depression have been present for at least

A) 2 weeks.
B) 4 weeks.
C) 3 months.
D) 6 months.

Question 21

____________ is among the MOST commonly abused substance among older adults.

A) Prescription medication
B) Alcohol
C) Over-the-counter medication
D) Tobacco

Question 22

Although not necessarily the recommended first line medication for this problem, the class of drugs most frequently prescribed to treat anxiety in older adults is

A) antidepressants.
B) benzodiazepines.
C) beta blockers.
D) buspirone.

Question 23

The incidence of late-life depression is _____ correlated with the incidence of major neurocognitive disorders.

A) negatively
B) not
C) minimally
D) positively

Question 24

Prescription drug abuse may only be noticeable in older adults when they

A) exhibit unusual behaviour changes (e.g., increased isolation, agitation, and aggression).
B) begin to sleep more, and this cannot be attributed to another psychological and/or medical disorder.
C) show signs of toxicity or withdrawal.
D) start to "doctor shop" in order to obtain medication.

Question 25

The most commonly diagnosed anxiety disorders in older adults are

A) generalized anxiety disorder and PTSD.
B) PTSD and social phobia.
C) generalized anxiety disorder and specific phobias.
D) acute stress disorder and panic disorder (with or without agoraphobia).

Question 26

Alcohol use poses particular hazards for aging people because

A) declining hormones make alcohol harder to digest.
B) alcohol's empty calories cause rapid weight gain.
C) elderly people who drink are often victims of crime.
D) loss of lean body mass decreases the body's ability to metabolize alcohol.

Question 27

When given a choice, older adults often prefer ____________ for the treatment of their anxiety symptoms.

A) medication
B) religious/spiritual counselling
C) psychosocial treatment
D) peer support

Question 28

Older adults who suffer from anxiety

A) often experience symptoms of depression first.
B) typically attribute their symptoms solely to medical conditions or medication reactions.
C) use more psychological terms to describe their symptoms compared with younger adults.
D) focus more on their physical symptoms than their psychological distress.

Question 29

Alcohol abuse at any age is not simply defined by the number of drinks consumed each day but also by the

A) adverse consequences that negatively impact functioning.
B) level of physical and mental addiction.
C) presence of withdrawal symptoms.
D) constant need to consume greater quantities to reach the same desired effect.

Question 30

In many cases, late-life depression simply reflects:

A) cognitive decline.
B) a secondary complication from medical issues.
C) recurrence of an earlier episode.
D) Neurological impairment.

Question 31

Anxiety in older adults may complicate medical conditions. Why?

A) Anxiety is linked to failure to take needed medications.
B) Anxious adults are more likely to self-medicate with over-the-counter medications and alcohol.
C) Anxious adults use more health care services and are less physically active.
D) Anxiety about health problems may make patients reluctant to see the doctor.

Question 32

The medication that is recommended as the first-line pharmacological treatment for older people suffering from anxiety is

A) buspirone.
B) beta blockers.
C) benzodiazepines.
D) antidepressants.

Question 33

Substance abuse in older adults may only be recognized when they

A) begin to have more legal issues as a result of their alcohol/drug use.
B) become increasingly isolated from family members, friends, and social activities.
C) start to show an increase in antisocial behaviours.
D) has adverse consequences, (medical, social, or psychological), that negatively impacts functioning.

Question 34

Treatment of depression in older adults should always begin with

A) medication therapy.
B) a complete physical examination.
C) psychological treatments, such as CBT.
D) inpatient hospitalization.

Question 35

As with depression, treatment for anxiety should always begin with

A) a complete medical evaluation.
B) medication therapy.
C) an in-depth psychosocial evaluation.
D) cognitive-behavioural therapy.

Question 36

Older men use alcohol at ____ the rate of women, and they are as many as ___ times more likely to be problem drinkers.

A) 49; 5 times.
B) 39; 3 times.
C) 45. 6 times.
D) 59; 6 times.

Question 37

Although the diagnostic criteria for anxiety disorders are consistent for all age groups, older adults typically worry more about matters such as

A) health, stressful life transitions, and care-giving responsibilities.
B) family, work, and physical limitations.
C) memory problems, stress, and disability.
D) health-care costs, generational differences, and decline in energy.

Question 38

A type of therapy that focuses on patients' recall of significant past events and how they managed distress is called

A) interpersonal therapy.
B) brief psychodynamic therapy.
C) reminiscence therapy.
D) cognitive behavioural therapy.

Question 39

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends that adults aged 65 and over have _______________.

A) no more than one drink per day, or seven drinks per week
B) at least two drinks per day
C) no more than one drink per week
D) one beer and one glass of wine per day to help them fall asleep

Question 40

The ____________ diathesis-stress model considers the role of biological predispositions, stressful life events, and personal protective factors that reduce the potential negative impact of biological and environmental risk factors in the development of late-onset depression.

A) life-span developmental
B) geropsychological developmental
C) gene-environment
D) differential susceptibility

Question 41

Millie is a 67-year-old woman who comes from a loving, stable middle class family. She reached all of her developmental milestones at the appropriate times and has no personal or family history of significant medical or psychiatric illnesses. Recently, however, Millie began experiencing hallucinations and having increased difficulty recalling names and locating objects. They do not interfere with her social or personal functioning but she and her family are concerned at this development. After a thorough examination by her primary care physician, Millie was referred to a neurologist for further testing where he found a brain tumor. Given this information, Millie would most likely be diagnosed with

A) vascular dementia.
B) subcortical dementia.
C) late-onset schizophrenia.
D) very-late-onset schizophrenia-like psychosis.

Question 42

In what way may hormonal factors influence the late onset of schizophrenia in women?

A) Estrogen may prevent psychotic symptoms before menopause.
B) Progesterone may prevent psychotic symptoms before menopause.
C) Hormonal imbalance may cause psychotic symptoms to appear in later life.
D) Sex hormones are unrelated to schizophrenic symptoms.

Question 43

Treatment for risky/problematic drinking in older adults is aimed at

A) prevention and early intervention.
B) detoxification and relapse prevention.
C) social skills training and daily living activities.
D) withdrawal safety and early intervention.

Question 44

Jack is a 79-year old man with multiple medical problems, including high blood pressure, diabetes, arthritis, several minor strokes, atherosclerosis, and degenerative disk disease. Jack sees several doctors, who all prescribe him medication. Recently, Jack's wife and children have noticed that he has become increasingly confused and they have to repeat questions because his attention wanders. After reviewing all of Jack's medications, his primary-care physician decided to either discontinue or reduce several of his prescriptions. Within a month, Jack's symptoms dramatically improved. Given this information, Jack would most likely be diagnosed with

A) neurocognitive disorder.
B) substance abuse.
C) delirium.
D) psychosis.

Question 45

Which medication is safe and beneficial for the treatment of alcohol abuse in older adults?

A) Benzodiazepines
B) Antidepressants
C) Disulfiram
D) Naltrexone

Question 46

As compared to the doses given to younger schizophrenics, the medication doses given to older adults with schizophrenia are

A) 25%-50% lower.
B) 15%-25% lower.
C) the same.
D) 25%-50% higher.

Question 47

____________ is an alteration in consciousness that typically occurs in the context of a medical illness or after ingesting a substance.

A) Neurocognitive Disorder
B) Delirium
C) Dissociation
D) Delirium tremens

Question 48

When the onset of substance abuse occurs later in life, researchers most often find

A) underlying genetic factors that result in the development of the disorder.
B) an increased level of stress at home and/or work.
C) a history of habitual use and/or risky drinking.
D) a previously undiagnosed mental illness.

Question 49

The psychological treatment that includes direct feedback about problematic drinking, advice about reducing alcohol consumption, and educational resources is called

A) cognitive-behavioural therapy.
B) brief alcohol counselling.
C) acceptance and commitment therapy.
D) extended alcohol counselling.

Question 50

As compared to schizophrenia more generally, very-late-onset schizophrenia-like psychosis

A) involves fewer positive symptoms.
B) is more clearly genetic in origin.
C) is more strongly associated with childhood maladjustment.
D) includes fewer negative symptoms.

Question 51

When older adults are treated for psychosis, which medications produce better outcomes and have fewer side effects?

A) Antidepressants
B) Typical antipsychotics
C) Atypical antipsychotics
D) Benzodiazepines

Question 52

Late-onset schizophrenia is:

A) more common among men than women
B) more common among women than men
C) more common among ethnic groups than Caucasians
D) more common among Caucasians than ethnic groups

Question 53

The prevalence of delirium among older hospitalized patients ranges from ____ to ____.

A) 1% to 4%
B) 5% to 12%
C) 14% to 56%
D) 60% to 79%

Question 54

In most older adults with schizophrenia, the disorder begins

A) in adolescence.
B) in young adulthood.
C) in middle age.
D) after the age of 65.

Question 55

Very-late-onset schizophrenia-like psychosis develops after the age of 65 and

A) is caused primarily by genetic abnormalities.
B) is characterized by more negative symptoms.
C) symptoms appear after a person has a stroke, tumor, or other neurodegenerative change.
D) there is evidence that as children patients experienced greater rates of maladjustment.

Question 56

Psychotic symptoms are more common among patients who

A) live alone or are hospitalized.
B) are diagnosed with schizophrenia later in life.
C) take large quantities of medications.
D) reside in nursing homes or are hospitalized.

Question 57

The first step in the treatment of delirium is

A) providing psychotherapy
B) manipulating the environment.
C) administering medication.
D) educating the family.

Question 58

Although there are many biological and environmental causes for delirium, the two primary causes are

A) serious systemic medical illness and medication toxicity.
B) alcohol/drug intoxication or withdrawal and genetic factors.
C) severe dehydration and neurological disorders.
D) metabolic disorders and malnutrition.

Question 59

As compared to schizophrenia more generally, late-onset schizophrenia

A) includes more negative symptoms.
B) more often reflects the paranoid subtype.
C) is associated with lower premorbid functioning.
D) is associated with fewer auditory hallucinations.

Question 60

Psychotic symptoms that occur with Alzheimer's disease is differentiated from those associated with late-life schizophrenia by the presence of

A) simple, concrete delusions and visual hallucinations.
B) persecutory delusions and auditory hallucinations.
C) somatic delusions and visual hallucinations.
D) grandiose delusions and auditory hallucinations.

Question 61

The clinical presentation of major or mild vascular neurocognitive disorder differs from Alzheimer's disease in that it has

A) a more gradual onset, more focal cognitive deficits, and a more stepwise progression of cognitive difficulties.
B) a sudden onset, more diffuse cognitive deficits, and a more gradual decline in cognitive abilities.
C) a more gradual onset, more diffuse cognitive deficits, and a more gradual decline in cognitive abilities.
D) a sudden onset, more focal cognitive deficits, and a more stepwise progression of cognitive difficulties.

Question 62

Psychological symptoms and disorders are a normal part of aging.

Question 63

____________ is caused by strokes, coronary artery disease, or untreated high blood pressure.

A) Major or minor Vascular neurocognitive disorder
B) Substance/medication-induced major or minor neurocognitive disorder
C) Neurocognitive disorder not otherwise specified
D) Neurocognitive disorder due to other general medical conditions

Question 64

High doses of vitamin ____________ have been used for the treatment of Alzheimer's disease.

A) A
B) C
C) D
D) E

Question 65

In contrast to delirium, the cognitive difficulties associated with neurocognitive disorder

A) result in alterations to a patient's level of consciousness or alertness.
B) occur suddenly and disappear in a relatively short amount of time.
C) fluctuate over the course of the disorder.
D) are not accompanied by changes in consciousness or alertness.

Question 66

Herman is an 82-year-old man who enjoys volunteering at his church, dancing with his wife of 59 years, and gardening. Six weeks ago, Herman suffered a major stroke. Physically, it left him partially paralyzed on his left side. Mentally, it resulted in severe memory impairments and his speech is severely garbled to the point that others cannot understand him. He has not shown any improvement in his symptoms despite weeks of therapy. Given this information, Herman would most likely be diagnosed with

A) neurocognitive disorder not otherwise specified.
B) substance/medication-induced major or minor neurocognitive disorder.
C) major or mild vascular neurocognitive disorder.
D) delirium.

Question 67

Alzheimer's disease involves twisted fibers in neurons. These are called:

A) vascular plaques.
B) neurofibrillary tangles.
C) cerebral senile plaques.
D) neurocognitive tangles.

Question 68

Brain abnormalities associated with Alzheimer's disease include

A) excessive amounts of neurofibrillary tangles and plaques.
B) smaller cerebral ventricles than can be accounted for by normal aging.
C) blocked blood vessels, which may result in tissue death.
D) damage that is confined primarily to the inner layers of brain tissue.

Question 69

In Amnestic Mild Cognitive Impairment, discussed in the Examining the Evidence section of the text, cognitive complaints center on

A) memory impairments.
B) language disturbances.
C) a failure to recognize or identify objects.
D) disturbances in executive functioning.

Question 70

____________ describes different syndromes characterized by persistent and multiple cognitive difficulties that create significant impairment in social or occupational functioning.

A) Delirium
B) Neurocognitive Disorder
C) Delirium tremens
D) Dissociative identity disorder

Question 71

Helen is a 72-year old widow who immigrated to Canada from Poland at the age of 11. About ten years ago, even though she was otherwise healthy, her family began to notice small slips in her memory, which included forgetting people's names and dates as well as repeating herself numerous times during the course of a conversation. Gradually, these slips worsened to the point that Helen would go out for a walk and find herself across town without having any idea how she got there or how to get back home. Worried for her safety, her family placed her in a nursing home three years ago. Since then, Helen's cognitive decline has only worsened. She does not recognize her family and she has lost the ability to speak in English. Helen now relies completely on others for self-care. Given this information, Helen would most likely be diagnosed with

A) neurocognitive disorder not otherwise specified.
B) vascular neurocognitive disorder.
C) neurocognitive disorder due to Alzheimer's Disease
D) delirium.

Question 72

Nonmedication interventions for the treatment of Alzheimer's disease

A) help slow the progression of the disease.
B) are used strictly with patients' family members to help them cope.
C) do not have a direct effect on the progression of the disease.
D) are used strictly with patients to improve cognitive functioning.

Question 73

In the Examining the Evidence section of the text, Mild Cognitive Impairment (MCI) is discussed in the context of

A) whether it is a medical condition or psychological disorder.
B) its role in the treatment of dementia patients.
C) whether it is a precursor of dementia or a separate syndrome.
D) how neuroimaging can be a valuable diagnostic tool for cognitive disorders, especially dementia.

Question 74

____________ refers to cognitive dysfunction resulting from a series of small strokes.

A) Neurocognitive disorder not otherwise specified
B) Major or mild vascular neurocognitive disorder
C) Substance/medication-induced major or minor neurocognitive disorder
D) Neurocognitive disorder due to other general medical conditions

Question 75

Mental engagement is _____ associated with the age of onset of neurocognitive disorders.

A) negatively
B) minimally
C) not
D) positively

Question 76

Older adults tend to focus on psychological symptoms of distress rather than on physical symptoms.

Question 77

People tend to age more successfully when they are able to modify their goals and choices to make the best use of their personal characteristics.

Question 78

Treatment for mild to moderate Alzheimer's disease includes medication that inhibits the breakdown of

A) acetylcholine.
B) dopamine.
C) norepinephrine.
D) epinephrine.

Question 79

Which subtype of dementia accounts for approximately 75% of all patients diagnosed with the disorder?

A) Major or Minor Vascular neurocognitive disorder
B) Substance/Medication-induced major or minor neurocognitive disorder
C) Major or Mild neurocognitive disorder due to Alzheimer's Disease
D) Neurocognitive disorder due to other general medical conditions

Question 80

As Alzheimer's progresses and symptom severity increases, treatment includes medication that blocks the overproduction of

A) norepinephrine.
B) acetylcholine.
C) glutamate.
D) epinephrine.