False: It is not known exactly why, but the female: male ratio actually decreases with age. It may reflect the increased importance of common risk factors such as chronic illness, changing psychosocial circumstances, hormonal or vascular factors in the aetiology of depression with advancing age (Copeland et al 2002, p. 381; Jacoby & Oppenheimer 2002, p. 636).

False: At this age, the incidence of dementia is less than 0.5%. Hence, the incidence of dementia presenting as depression would be substantially less than this. Although an exact incidence rate of depression at this age is difficult to establish, it would be much higher than that of dementia. Therefore, depression is the more likely diagnosis (Johnstone et al 2004, p. 646; Schweitzer et al 2002).

False: A positive DST differentiates depressed patients from healthy controls in most but not all cases, especially in melancholic or psychotic depressions. The DST does not differentiate between depressed and other patient groups (for example those who abuse alcohol) sufficiently well to be used as a diagnostic test (Gelder et al 2000, p. 715).

True: About 10–20% of generalized anxiety disorders in the elderly are new cases. They often follow adverse life events or physical illness (Jacoby & Oppenheimer 2002, p. 698).

True: Hearing impairment has been experimentally and clinically associated with the development of paranoid symptoms (Copeland et al 2002, p. 505).

False: Kraepelin’s (1909) paraphrenia included patients with chronic delusions and hallucinations without the characteristic personality deterioration of dementia praecox. Roth’s (1965) ‘late paraphrenia’ described paranoid conditions starting after age 60 years in a setting of well preserved personality and affective response. Recent follow-up studies of patients with late paraphrenia show heterogeneous outcomes with only some developing dementia. This may not be significantly more than the number of cases of dementia expected in this age group anyway (Johnstone et al 2004, p. 644).

False: The prognosis of Diogenes syndrome is very poor. Inpatient admission, training, supervision and rehabilitation are almost inevitably followed by relapse into squalid conditions. Indefinite daycare may maintain improvements for longer periods, but often institutional or residential care becomes necessary. Hospital admission is also associated with high mortality (Gelder et al 2006, p. 515; Jacoby & Oppenheimer 2002, p. 730).

True: Viruses that can cause dementia include HIV and possibly herpes simplex virus and cytomegalovirus (Jacoby & Oppenheimer 2002, p. 495; Mitchell 2004, p. 199).

True: Although smoking was once believed to reduce the risk of developing Alzheimer’s disease, more recent evidence suggests that the opposite may be true (Jacoby & Oppenheimer 2002, p. 827).

False: Recognition involves being able to recognize but not recall spontaneously an answer to a question. Recall involves actively searching the memory stores and reproducing something that was learnt. Recall is probably more cognitively demanding and hence is affected before recognition in Alzheimer’s disease. However, both recall and recognition are severely affected in Alzheimer’s disease (Hodges 1994, p. 36; Mitchell 2004, p. 280).

True: Parkinson’s disease is associated with Lewy bodies in the brainstem region, whereas Lewy body dementia is associated with diffuse Lewy bodies. Parkinson’s disease and Lewy body dementia are now considered to be part of a spectrum of disorders (Gelder et al 2000, p. 415; Lishman 1997, p. 450; Mitchell 2004, p. 292).

True: Semantic dementia or temporal variant of fronto-temporal dementia is seen with focal cortical atrophy of the dominant lateral temporal neocortex (Gelder et al 2000, p. 274; Lishman 1997, p. 754; Mitchell 2004, p. 289; Sadock & Sadock 2005, p. 3634).

False: Pick’s disease accounts for about 1–2% of all dementias, fronto-temporal dementia for about 7% and Alzheimer’s disease for 50%. Dementia of frontal type refers to the clinical presentation of the dementia. Therefore Alzheimer’s disease is much more likely to present with dementia of frontal type than Pick’s (Gelder et al 2000, p. 398).

False: In Western countries, Alzheimer’s disease accounts for 50–70% and vascular dementia for 20–30% of all dementias. The prevalence rate for dementia doubles every 5.1 years, Alzheimer’s disease every 4.5 years and vascular dementia every 5.3 years. Even though in many non-Western countries vascular dementia is relatively more common, the trend is changing (Jacoby & Oppenheimer 2002, p. 487).

False: The entorhinal cortex receives afferents from the sensory areas and sends efferents to the hippocampus. Loss of neurons in this area is seen with memory loss and even in very mild Alzheimer’s disease, but not in normal ageing (Esiri 2004, p. 116; Mitchell 2004, p. 257).

False: Most studies have shown some cortical changes including mild volume reductions in the prefrontal and medial temporal regions (Jacoby & Oppenheimer 2002, p. 279).

False: Leukoaraiosis is a diminution of white matter intensity in the periventricular regions on brain imaging. It is thought to be ischaemic in origin. Although it is associated with vascular dementia and although its presence does worsen the prognosis, it is not strongly associated with cognitive decline in itself. It seems that it might act as a marker for ‘brain ageing’ and might suggest vulnerability to future compromise (Copeland et al 2002, pp. 23, 252).

False: The sulci are widened and the gyri narrowed (Johnstone et al 2004, p. 70).

True: Pick’s disease is characterized pathologically by circumscribed, asymmetrical knife-blade fronto-temporal atrophy (Gelder et al 2006, p. 342; Mitchell 2004, p. 44).

False: Day hospitals may reduce admissions when compared to no treatment at all. However, compared to other treatments, day hospitals are not definitively proven to reduce admission rates (Copeland et al 2002, p. 682; Johnstone et al 2004, p. 615).

True: Hypertension is a risk factor for the development of Alzheimer’s disease. Treating systolic hypertension in the elderly reduces the rates of dementia including Alzheimer’s disease (Jacoby & Oppenheimer 2002, p. 523).

False: Drug-induced morbidity is a major problem in the elderly, partly because of the changes in pharmacokinetics. ECT is at least as safe as antidepressants (Copeland et al 2002, p. 434).

False: Approximately 40–50% of patients with mild to moderate Alzheimer’s disease respond to treatment. A few show a dramatic response, while the majority show a modest benefit of relative stability or slower decline. They enhance not only cognition, but also non-cognitive symptoms, quality of life and ability to perform activities of daily living (Johnstone et al 2004, p. 636; Mitchell 2004, p. 425).

False: Donepezil is an acetylcholinesterase inhibitor (Johnstone et al 2004, p. 636).

False: Rivastigmine inhibits both acetylcholinesterase and butyryl cholinesterase (Johnstone et al 2004, p. 636).