True: There is a particularly strong risk for depression associated with ‘pseudodementia’, i.e. depression with cognitive impairment that resolves on remission of depression. There may be many reasons for the association between depression and dementia. Dementia may lead to depression as a result of increased subjective awareness of cognitive decline. Alternatively, a common factor may cause both depression and dementia (an example of this might be atherosclerosis). Depression may increase the risk of dementia via behaviours that increase the risk of vascular dementia such as smoking. These risks may also apply to depression occurring in midlife (Jacoby & Oppenheimer 2002, p. 637; Mitchell 2004, p. 277).

False: Factors associated with poor outcomes include a slower initial improvement, incomplete recovery, more severe initial depression, duration of illness more than 2 years, three or more previous episodes of depression, previous episodes of dysthymia, psychotic symptoms and certain types of brain disease (Gelder et al 2000, p. 1647; Jacoby & Oppenheimer 2002, p. 663).

False: Up to 12% of elderly patients with mania do not develop depressive episodes. They have unipolar mania. Unipolar mania is more likely to be secondary mania due to an organic cause (Johnstone et al 2004, p. 648; Mitchell 2004, p. 439).

True: Higher cortical functions such as praxis are preserved in depressive pseudodementia but lost in true dementia, though not necessarily in the early stages. Verbal fluency and delayed recall is usually more severely affected in true dementias even in the early stages (Lishman 1997, p. 488; Mitchell 2004, p. 277).

False: Paranoid or schizoid personality traits have been found in up to 45% of patients with late onset schizophrenia. These include jealousy, suspiciousness, emotional coldness, arrogance, egocentricity, explosiveness, oversensitivity and extreme solitariness. They also have lower rates of marriage and lower fecundity (Jacoby & Oppenheimer 2002, p. 754).

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, personality reaction to stress and loneliness have been suggested, it is generally thought to involve a complex interplay of personality traits, psychosocial stressors and medical/psychiatric conditions (Jacoby & Oppenheimer 2002, p. 730).

True: The doubling of prevalence for every 5 years is a generally accepted ‘rule of thumb’. The prevalence of dementia is c. 1% in 65–69-year-olds and c. 12% in 80–84-year-olds. The prevalence increases even more steeply after age 85 years (Butler & Pitt 1998, p. 50; Mitchell 2004, p. 258).

False: Cerebral palsy is not considered an independent risk factor.

False: The role of HRT in preventing Alzheimer’s disease is currently a source of much debate. It appears that the neuroprotection offered by oestrogen may depend on individual patient factors (Bluming 2004; Jacoby & Oppenheimer 2002, p. 495).

False: Stepwise cognitive decline is a feature of multi-infarct dementia. The key features of Lewy body dementia include fluctuating cognition with pronounced disturbances in attention and concentration, visual hallucinations and spontaneous Parkinsonism (Johnstone et al 2004, p. 633; Mitchell 2004, p. 292).

False: Praxis relates to ‘putting ideas into action’. Praxis is usually spared in Pick’s disease (Lishman 1997, p. 461).

True: Hachinski Ischaemia Score incorporates the cardinal features of vascular dementia. It can differentiate Alzheimer’s disease from vascular dementia. However, it cannot differentiate between vascular dementia and Alzheimer’s disease with cerebrovascular disease (Gelder et al 2000, p. 432; Lishman 1997, p. 456).

True: Gait disturbances occur in up to 25% of patients with vascular dementia. They are included in the DSM-IV criteria for vascular dementia and the NINDS-AIREN criteria for probable vascular dementia. Gait may be hemiplegic, apraxic-ataxic, short-stepped or Parkinsonian. Gait disorders are more common in vascular dementia than in Alzheimer’s disease (Gelder et al 2000, p. 431).

False: Glial cells are 10 times more numerous than neurons. The oligodendrocytes and Schwann cells form the myelin sheaths. The astrocytes participate in the blood–brain barrier, remove certain neurotransmitters from the synaptic cleft, buffer the extracellular potassium concentration and possibly have a nutritive role. The microglia serve as scavengers. With ageing, oligodendrocytes are decreased, consistent with disproportionate white matter loss on MRI, but astrocytes and microglia are increased (Lawlor 2001, p. 224; Sadock & Sadock 2005, pp. 4, 3613).

False: Dolan and colleagues in 1985 studied CT brain scans of 101 patients with depression. Although their ventricles were enlarged relative to healthy controls, the degree of enlargement did not relate to illness duration or treatment parameters, suggesting that ventricular enlargement antedated the onset of the illness (Lishman 1997, p. 140).

True: Tau protein is important in stabilizing the microtubules in the neuronal cytoplasm. Hyperphosphorylation is seen in Alzheimer’s disease (Johnstone et al 2004, p. 68; Lishman 1997, p. 442; Mitchell 2004, p. 272).

True: Tau protein normally plays a role in the cytoskeleton, linking neurofilaments and microtubules. Paired helices of tau form neurofibrillary tangles (Lishman 1997, p. 442).

False: White matter lesions are associated with a worse prognosis. This may be because they are reflective of underlying generalized vascular pathology (Briley et al 2000).

False: The Barthel index is a standardized assessment scale for activities of daily living (Jacoby & Oppenheimer 2002, p. 229).

False: The correct figure is 1 per 10 000. Of 10 000 people over 65 years, there will be on average 500 with dementia, 1400 with depression, 160 with psychosis and 160 with other conditions (Jacoby & Oppenheimer 2002, p. 430).

False: Ageing decreases gastric acid secretion. The prevalence of gastric achlorhydria increases with age. The elderly have reduced gastric acid production, gastric emptying, gastrointestinal motility, absorptive gut surface area and intestinal blood flow, all of which may reduce the absorption of some drugs (Jacoby & Oppenheimer 2002, p. 286; King 2004, p. 449; Sadock & Sadock 2005, p. 3717).

True: Maintenance therapy is thought to reduce rates of relapse by a factor of up to 2.5. Up to 70% of patients on maintenance treatment may remain well at 4 years (Copeland et al 2002, p. 440; Johnstone et al 2004, p. 647; King 2004, p. 460).

True: This area is controversial. Cholinesterase inhibitors are considered to be most effective in mild to moderate dementia. Hence, the NICE guidelines suggest discontinuing them if the MMSE scores drop below 12/30 (BNF 2005, 4.11; Jacoby & Oppenheimer 2002, p. 572; NICE).

True: Memantine is an NMDA (N-Methyl-D-Aspartate) receptor antagonist. It has been used in moderate to severe Alzheimer’s dementia (BNF 2005, 4.11).

True: Antioxidant therapy has been tried in Alzheimer’s disease. This is based on the hypothesis that cellular respiration produces oxygen derivatives and other free radicals that may be harmful to intracellular structures. Vitamin E and vitamin C have been tried in Alzheimer’s disease. The results have been conflicting, though predominantly negative (Jacoby & Oppenheimer 2002, pp. 496, 574).