Neurologic and Psychiatric Disorders
What to know
Stroke and TIA: recognize acute deficits, time of onset, and thrombolysis windows; secondary prevention (antiplatelet/anticoagulation, BP, lipids). Parkinson disease: resting tremor, rigidity, bradykinesia; treat with levodopa; watch for orthostasis, hallucinations, and drug interactions. Peripheral neuropathy (diabetes, B12) causes falls. Depression is common and underrecognized-screen with PHQ-2/9; it can mimic dementia. Anxiety, insomnia, and substance use (including alcohol) warrant attention. Seizures can present atypically in elders. Normal pressure hydrocephalus triad: gait apraxia, incontinence, cognitive decline.
Traps
Depression vs dementia (pseudodementia) is a classic testing point. Parkinson patients are sensitive to antipsychotics and can develop impulse-control disorders on dopamine agonists. Don't attribute new neurologic deficits to "age." Atypical stroke presentations (confusion, falls) are common. Benzodiazepines worsen cognition and falls-avoid for insomnia.
Rule of thumb
"Screen mood before labeling memory": treat depression and reassess cognition.
Worked example
An 80-year-old with new gait disturbance, urinary incontinence, and cognitive decline: consider normal pressure hydrocephalus; imaging and specialist referral are indicated, and shunt response is possible.
Worked example 2
A Parkinson patient with hallucinations: reduce dopamine agonists first and avoid typical antipsychotics; consider quetiapine or clozapine with caution.