True: Short-term memory as tested by digit span does not decline with age as much as verbal skills, e.g. verbal fluency, do. Sensory memory or extremely brief sensory record of a stimulus; primary memory, e.g. by the ability to recall a series of digits long enough to repeat them; and tertiary memory or memories of childhood have no significant age effects. Verbal expression and verbal reasoning skills show subtle changes with age and language may become less precise and more repetitious over time. However, performance IQ declines more rapidly than verbal in the elderly (Sadock & Sadock 2005, p. 3628).

False: Episodes of depression tend to last longer in old age. When depression is untreated one-third remain unwell at 3-year follow-up. However, with treatment the prognosis of late-life depression can be as good as that of depression in younger adults. This emphasizes the need for early detection and adequate treatment of depression in the elderly. However, true comparative studies with depression in younger people are rare (Lawlor 2001, p. 228; Norman & Redfern 1996, p. 154).

False: Lithium or another mood stabilizer + an antipsychotic combination is the most common treatment (Gelder et al 2000, p. 1650; Jacoby & Oppenheimer 2002, p. 689; Johnstone et al 2004, p. 648).

True: Late onset schizophrenia is 3–9 times more common in women than in men (Butler & Pitt 1998, p. 153).

True: Fecundity relates to the potential reproductive capacity of an organism. Patients with late onset delusional disorders are less likely to have been married. They have fewer children even if they were married (Johnstone et al 2004, p. 644).

False: Diogenes syndrome, senile self-neglect or senile squalor is characterized by severe self-neglect unaccompanied by any psychiatric disorder sufficient to account for the squalor in which the patient exists. Although burnt out personality disorder, end-stage personality disorder or personality reaction to stress and loneliness have been suggested, it is currently thought to involve a complex interplay of personality traits, psychosocial stressors and medical/psychiatric conditions. If delusions were causing the presentation, then the patient would receive a diagnosis relating to those delusions, e.g. late onset schizophrenia with secondary extreme self-neglect, and not Diogenes syndrome. The syndrome is named after the Greek philosopher ‘Diogenes the cynic’ (412–323 BC). He attempted to have as simple a life as possible and allegedly lived in a wooden tub belonging to the temple of Cybele (Jacoby & Oppenheimer 2002, p. 730; Sims 2004, p. 371; Wright et al 2005, p. 487).

False: Mild cognitive impairment is usually considered an intermediate state between normal ageing and dementia. It is characterized by subjective complaints of poor memory and objective evidence of impaired memory for age and education but with preserved general cognitive function and intact activities of daily living in the absence of dementia. The progression to dementia is 10–15%/year (Copeland et al 2002, p. 306; Johnstone et al 2004, p. 628; Mitchell 2004, p. 265).

False: Mutations in the amyloid precursor protein gene are thought to account for only a proportion of the 5% of cases of familial Alzheimer’s disease (Johnstone et al 2004, p. 630).

False: In the early stages of Alzheimer’s disease, there is failure of new learning. Hence, memory for recent events is impaired while the recall of previously learned information remains good. As the disease progresses the memory impairment broadens to involve retrieval of more and more distant memories. This results in the patient appearing to live in the ever-more-distant past (Jacoby & Oppenheimer 2002, p. 512; Mitchell 2004, p. 280).

True: The consensus criteria for Lewy body dementia include progressive decline in cognitive functions and two of the following core features: fluctuating cognition, visual hallucinations, motor features of Parkinsonism (Johnstone et al 2004, p. 633; Mitchell 2004, p. 261).

False: Semantic dementia or progressive fluent aphasia is a frontotemporal dementia in which the patient loses their ability to understand and recognize words. The language disorder is characterized by progressive, fluent, empty, spontaneous speech. Loss of word meaning is manifest by impaired naming and comprehension and semantic paraphasias. The ability to list objects from a class is impaired (Lishman 1997, p. 753; Mitchell 2004, p. 289).

False: Pick’s typically begins with changes of character and social behaviour before progressing to deficits in spatial orientation and memory. Praxis is generally preserved until late in the disease (Lishman 1997, p. 461).

True: Pick’s is characterized by changes in personality and behaviour, affective symptoms, and a progressive reduction of expressive speech (Gelder et al 2000, p. 398; Mitchell 2004, p. 288).

True: Senile plaques and neurofibrillary tangles appear in normal ageing (Esiri et al 2004, p. 113; Sadock & Sadock 2005, p. 3611).

True: Elderly patients with a first episode of depression have larger ventricles than age-matched healthy controls. This may be predictive of increased mortality on follow-up (Lishman 1997, p. 140).

False: The earliest changes seen on neuroimaging are usually in the hippocampus. This is consistent with the clinical picture where laying down of new memories is often the first deficit noted in dementia (Esiri et al 2004, p. 168; Mitchell 2004, p. 268).

True: The term ‘agnosia’ was introduced by Freud in 1891. Agnosia is a failure of recognition which is not due to a primary sensory defect or to generalized intellectual impairment. Progressive deterioration of cognitive functions such as language (aphasia), motor skills (apraxia) and perception (agnosia) is a NINCDS-ADRDA criterion for the diagnosis of probable Alzheimer’s disease. According to NINDS-AIREN criteria, progressive worsening of memory and other cognitive functions in the absence of corresponding focal lesions on brain imaging make the diagnosis of vascular dementia unlikely (Johnstone et al 2004, p. 630; Lishman 1997, p. 58; Mitchell 2004, p. 74).

True: Neurofibrillary tangles are intraneuronal aggregations of insoluble phosphorylated tau protein. Neurofibrillary tangles are not specific for Alzheimer’s disease. They are found in the normal elderly as well as in other neurodegenerative disorders such as dementia pugilistica. In Lewy body dementia, neurofibrillary tangles are typically few or absent (Gelder et al 2006, p. 340; Johnstone et al 2004, p. 71; Lishman 1997, p. 453).

True: Leukoaraiosis (Greek for white matter of loose texture) is a diminution of white matter intensity in the periventricular regions on brain imaging. It is thought to be ischaemic in origin. It is associated with limb weakness, extensor plantars and gait disturbances. Both leukoaraiosis and gait disturbance suggest poorer prognosis (Briley et al 2000; Copeland et al 2002, pp. 23, 252; Lishman 1997, p. 460).

False: Male carers more commonly abuse male patients and female carers more commonly abuse females (Payne & Cikovic 1995).

False: There is no single strategy that suits all patients. Some patients will accept a brief admission to the hospital in order to get to the bottom of the problem. A compulsory admission may reduce the prospect of establishing a trusting relationship. The need for admission depends on such factors as risk, associated distress, response to interventions delivered to their homes and response to attendance at day hospitals and day centres (Jacoby & Oppenheimer 2002, p. 755).

True: The relative proportion of body fat increases and the total body water decreases with age. Consequently, the half-life of lipid soluble drugs is increased. Other changes include reduced hepatic metabolism and renal function (King 2004, p. 449; Norman & Redfern 1996, p. 421).

True: Common side-effects of SSRIs in the elderly include anxiety/agitation (2–15%), nausea (15%), diarrhoea (10%) and insomnia (5–15%) (Jacoby & Oppenheimer 2002, p. 653).

True: Donepezil has a half-life of 70 hours, lending itself to once daily administration (Johnstone et al 2004, p. 636).

True: Memantine is an NMDA channel blocker. It is used in moderate to severe Alzheimer’s dementia (BNF 2005, 4.11; Mitchell 2004, p. 370).