ABPN Geriatric Psychiatry key terms

Cognitive impairment that mimics dementia but is caused mainly by depression; patients often answer 'I don't know,' show variable effort, and improve when mood is treated.

Acute, fluctuating disturbance of attention and awareness, usually from a medical cause, medications, or withdrawal; it develops over hours to days and is frequently missed in older adults.

A brief structured screening tool for delirium requiring acute onset with fluctuation plus inattention, and either disorganized thinking or altered level of consciousness.

Objective cognitive decline greater than expected for age that does not substantially impair daily function; it raises but does not guarantee the risk of progressing to dementia.

A 30-point bedside test of orientation, registration, attention, recall, language, and construction; scores are adjusted for education and fall with age and sensory impairment.

A 30-point screening instrument more sensitive than the MMSE to mild impairment, especially executive and visuospatial deficits; a score below 26 suggests cognitive impairment.

Progressive neurodegenerative dementia with insidious short-term memory loss and later language, visuospatial, and functional decline; it is the most common cause of dementia in late life.

Dementia with fluctuating cognition, recurrent well-formed visual hallucinations, parkinsonism, and sensitivity to antipsychotics; REM sleep behavior disorder often precedes diagnosis.

Neurodegeneration of frontal and temporal lobes causing early personality change, disinhibition, or language deficits, with relative sparing of memory and visuospatial skills early on.

Cognitive impairment attributed to cerebrovascular disease, typically with stepwise decline, executive slowing, and focal neurologic findings; risk factors include hypertension, diabetes, and prior stroke.

Donepezil, rivastigmine, and galantamine, which raise synaptic acetylcholine and modestly slow symptom progression in Alzheimer disease; adverse effects include nausea, bradycardia, and diarrhea.

An NMDA receptor antagonist used for moderate to severe Alzheimer disease, often added to a cholinesterase inhibitor; it is renally cleared and may cause dizziness or confusion.

Severe rigidity, sedation, or worsening confusion after even small antipsychotic doses, classically seen in Lewy body dementia; it warrants avoiding or minimizing these drugs.

A yes/no self-report screen for depression in older adults that omits somatic items; the 15-item short form scores 5 or more as suggestive of depression.

Depressive illness arising after age 60, often with prominent somatic complaints, apathy, cognitive slowing, and higher relapse risk; it is associated with vascular disease and suicide risk.

Induction of a controlled seizure under anesthesia to treat severe depression, catatonia, or psychosis; it is effective in older adults but requires attention to cardiac and cognitive effects.

A toxic reaction to serotonergic drugs causing agitation, tremor, clonus, hyperreflexia, fever, and autonomic instability; it can be fatal and requires stopping the offending agents.

A life-threatening reaction to dopamine-blocking drugs with rigidity, high fever, autonomic instability, and elevated creatine kinase; treatment includes stopping the drug and supportive care.

Involuntary repetitive movements, often of the mouth, tongue, or face, arising after prolonged dopamine-blocking treatment; older adults are at elevated risk and symptoms may persist.

The cumulative effect of drugs blocking acetylcholine, which can cause confusion, constipation, urinary retention, dry mouth, and falls; it is a common reversible contributor to cognitive decline.

A gradual, planned dose reduction of benzodiazepines or related sedative-hypnotics to limit falls, confusion, and dependence; abrupt cessation risks withdrawal seizures.

An expert consensus list of medications potentially inappropriate for older adults because of high risk of adverse effects, used to guide safer prescribing and medication review.

Concurrent use of multiple medications, often defined as five or more; in older adults it raises risks of interactions, adverse effects, and hospitalization and warrants periodic review.

Evaluation of a patient's ability to understand relevant information, appreciate consequences, reason about options, and communicate a choice for a specific decision.

A written statement made while a person has capacity that records future treatment preferences or names a surrogate decision-maker for when the person can no longer decide.

A court-appointed arrangement in which a person or agency makes decisions for someone found unable to manage personal or financial affairs; it is the least restrictive alternative last.

Physical, emotional, sexual, or financial harm, neglect, or abandonment of an older adult, often by a caregiver or family member; clinicians are typically mandated to report suspected cases.

The physical, emotional, and financial strain experienced by people caring for an impaired older adult; it predicts depression, institutionalization, and risk of mistreatment.

Temporary relief for family caregivers through short-term professional or residential care of the patient, intended to reduce burden and sustain home caregiving.

Worsening of confusion, agitation, or disorientation in late afternoon or evening, common in dementia; contributors include fatigue, poor lighting, and disrupted routine.

Agitation, aggression, psychosis, mood changes, and other noncognitive symptoms of dementia; first-line management is nonpharmacologic, with medications reserved for severe or dangerous symptoms.

Reduced motivation and goal-directed behavior without distress, common in dementia and depression; it can be mistaken for depression but lacks prominent sadness or guilt.

Elevated risk in late life, especially in older men, often associated with depression, chronic illness, isolation, and access to lethal means; intent may be communicated indirectly.

A neurodegenerative language disorder with gradual loss of word finding or comprehension while other cognitive domains remain relatively preserved early; it is a variant of frontotemporal degeneration.

Deposition of amyloid in small cerebral vessels that predisposes to lobar hemorrhages and cognitive decline; it is a concern when anticoagulating older patients with cognitive impairment.