Dementia and Delirium Practice Questions

30 multiple-choice questions on Dementia and delirium for paramedic and EMT students, from Chapter 19 (Neurologic Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. A 74-year-old widow says her memory is terrible and answers many questions with 'I don't know.' She has lost interest in her hobbies and sleeps poorly since her husband died. What should be considered?

   1. A. Depression affecting her thinking
   2. B. Advanced Alzheimer disease
   3. C. Frontotemporal dementia
   4. D. Normal forgetting that comes with age
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   Answer: A. Depression affecting her thinking

   Depression in older adults can cause poor concentration and memory complaints (sometimes called pseudodementia). These patients often emphasize their memory problems and answer 'I don't know,' and the condition improves with treatment, so it is important to recognize. Advanced Alzheimer disease usually comes with unawareness of the deficits, frontotemporal dementia presents with disinhibition and personality change, and normal aging does not cause loss of interest and poor sleep.

2. The hallmark cognitive deficit of delirium is impaired:

   1. A. Long-term memory
   2. B. Orientation to time
   3. C. Speech articulation
   4. D. Attention
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   Answer: D. Attention

   Inattention is the core feature of delirium; patients cannot focus, sustain, or shift attention, and often cannot follow a conversation. Disorientation to time is common but follows from the attention problem and also occurs in dementia, long-term memory is affected mainly in dementia, and slurred articulation points to dysarthria rather than delirium.

3. Delirium should be treated in the field primarily as:

   1. A. A medical emergency
   2. B. A form of early dementia
   3. C. A psychiatric disorder only
   4. D. A problem for the primary doctor
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   Answer: A. A medical emergency

   Delirium signals an acute underlying medical problem such as infection, hypoxia, drug toxicity, or metabolic derangement and is associated with high mortality. It comes on over hours to days and is not a form of dementia, although it is more common in people who have dementia, so it should not be left for a routine primary care visit or treated as purely psychiatric.

4. The most common cause of dementia is:

   1. A. Vascular dementia
   2. B. Lewy body dementia
   3. C. Huntington disease
   4. D. Alzheimer disease
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   Answer: D. Alzheimer disease

   Alzheimer disease accounts for the majority of dementia cases and causes gradual, progressive loss of memory and other cognitive functions.

5. A family reports their father's cognition declined in sudden steps over several years, each after a "small stroke." This suggests:

   1. A. Alzheimer disease
   2. B. Frontotemporal dementia
   3. C. Vascular dementia
   4. D. Acute delirium
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   Answer: C. Vascular dementia

   Vascular dementia often shows a stepwise decline associated with cerebrovascular events and shares risk factors with stroke.

6. An older man with dementia has vivid visual hallucinations, fluctuating alertness, and a shuffling gait. This most suggests:

   1. A. Alzheimer disease
   2. B. Lewy body dementia
   3. C. Vascular dementia
   4. D. Korsakoff syndrome
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   Answer: B. Lewy body dementia

   Lewy body dementia features fluctuating cognition, well-formed visual hallucinations, and parkinsonism; these patients can react severely to antipsychotics.

7. A 56-year-old has gradual changes in personality, disinhibition, and poor judgment with relatively preserved memory. This most suggests:

   1. A. Frontotemporal dementia
   2. B. Alzheimer disease
   3. C. Acute delirium
   4. D. Parkinson disease
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   Answer: A. Frontotemporal dementia

   Frontotemporal dementia often begins earlier than Alzheimer disease and presents with behavioral and personality change or language problems.

8. The classic triad of normal pressure hydrocephalus is:

   1. A. Headache, fever, and neck stiffness
   2. B. Tremor, rigidity, and bradykinesia
   3. C. Ataxia, nystagmus, and confusion
   4. D. Gait change, incontinence, dementia
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   Answer: D. Gait change, incontinence, dementia

   NPH causes the triad of gait disturbance, urinary incontinence, and cognitive decline ("wet, wobbly, and wacky") and is potentially treatable with a shunt.

9. A 76-year-old with Parkinson disease recently had his dopamine medicine dose increased. He now sees people and animals in the room that are not there, but he is otherwise alert and oriented. What should be considered?

   1. A. A new primary psychiatric illness
   2. B. His Parkinson drug's side effect
   3. C. Opioid toxicity from his pain pills
   4. D. An absence seizure in adulthood
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   Answer: B. His Parkinson drug's side effect

   Levodopa and dopamine agonists commonly cause visual hallucinations, especially in older patients and after a dose increase, and they are also a feature of Parkinson disease dementia. Report the medicine change, and avoid haloperidol, which can severely worsen parkinsonism. A new psychiatric illness is unlikely at this age with a clear drug trigger, opioids cause sedation rather than hallucinations in an alert patient, and absence seizures cause brief staring.

10. Which is the most common precipitant of delirium in older adults?

    1. A. Sleep deprivation
    2. B. Infection
    3. C. Caffeine use
    4. D. Mild anemia
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    Answer: B. Infection

    Urinary tract infections and pneumonia are among the most common causes of delirium in the elderly, often without prominent fever.

11. A delirious 85-year-old keeps trying to get out of bed. Staff ask whether to tie her wrists to the bed rails for the night. What is the best response?

    1. A. Restraints are the safest first step
    2. B. Restraints tend to worsen delirium
    3. C. Restraints treat the cause of delirium
    4. D. Restraints are needed in most delirium
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    Answer: B. Restraints tend to worsen delirium

    Physical restraints increase agitation, falls, injuries and the length of delirium, so they are a last resort. Better first steps include treating the cause, having someone stay with her, reorienting her, and addressing pain, a full bladder or hunger. Restraints are not the safest first step, they do not treat the underlying cause, and most delirious patients do not need them.

12. A nursing home resident is quiet, drowsy, and inattentive, which is new. Staff thought she was "just tired." This may be:

    1. A. Normal sundowning
    2. B. Stable dementia
    3. C. Expected fatigue
    4. D. Hypoactive delirium
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    Answer: D. Hypoactive delirium

    Hypoactive delirium presents with lethargy and reduced activity and is frequently missed, yet it carries a worse prognosis than hyperactive delirium.

13. The Confusion Assessment Method requires acute onset or fluctuating course plus:

    1. A. Hallucinations
    2. B. Severe agitation
    3. C. Inattention
    4. D. Fever
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    Answer: C. Inattention

    CAM-positive delirium requires acute onset or fluctuating course and inattention, plus either disorganized thinking or an altered level of consciousness.

14. Increased confusion and agitation in a dementia patient in the late afternoon and evening is called:

    1. A. Delirium tremens
    2. B. Sundowning
    3. C. Catatonia
    4. D. Akathisia
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    Answer: B. Sundowning

    Sundowning is a pattern of worsening behavior later in the day. A sudden new change still warrants a search for medical causes.

15. Which communication technique is most helpful with a patient who has moderate dementia?

    1. A. Short, simple sentences
    2. B. Rapid multi-step instructions
    3. C. Speaking loudly from a distance
    4. D. Arguing to correct false beliefs
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    Answer: A. Short, simple sentences

    Approach calmly, face the patient, use the patient's name, and give one simple instruction at a time to reduce confusion and agitation.

16. Two days after starting ciprofloxacin for a urinary infection, an 83-year-old has become confused and agitated with poor sleep. Which cause should be considered along with the infection itself?

    1. A. Rapidly progressive Alzheimer disease
    2. B. Normal pressure hydrocephalus
    3. C. A primary psychiatric illness
    4. D. A drug side effect of the antibiotic
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    Answer: D. A drug side effect of the antibiotic

    Fluoroquinolone antibiotics such as ciprofloxacin can cause central nervous system effects, including confusion, agitation, insomnia and, rarely, seizures, especially in older adults and those with kidney disease. A new drug started just before the change is an important clue to report. Alzheimer disease does not progress over 2 days, normal pressure hydrocephalus develops over months with gait change and incontinence, and a new psychiatric illness is unlikely with a clear medical trigger.

17. A daughter asks why her father is still confused a week after his pneumonia was treated, even though he is improving physically. Which explanation is most accurate?

    1. A. It means he now has a permanent dementia
    2. B. Delirium should end within hours
    3. C. It proves the antibiotics have failed
    4. D. Delirium may last weeks after the cause
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    Answer: D. Delirium may last weeks after the cause

    Delirium often improves over days to weeks after its cause is treated, and in older patients it can persist for weeks or longer. It does not by itself mean permanent dementia, although delirium does raise the risk of later cognitive decline. Delirium does not reliably end within hours, and ongoing confusion alone does not prove treatment failure, although new causes should be considered.

18. A 72-year-old notices she forgets names and appointments more than before, but she still manages her money, cooking, driving and medicines on her own. Which description fits best?

    1. A. Moderate Alzheimer dementia
    2. B. Acute delirium
    3. C. Normal pressure hydrocephalus
    4. D. Mild cognitive impairment
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    Answer: D. Mild cognitive impairment

    Mild cognitive impairment means memory or thinking problems greater than expected for age while daily activities remain independent. Dementia, such as moderate Alzheimer disease, impairs daily function. Delirium is an acute disturbance of attention, and normal pressure hydrocephalus causes gait change and incontinence along with cognitive problems.

19. Why should benzodiazepines be used cautiously for agitation in elderly delirious patients?

    1. A. They prolong the QT interval
    2. B. They lower the seizure threshold
    3. C. They can worsen delirium
    4. D. They are weaker in older adults
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    Answer: C. They can worsen delirium

    Benzodiazepines frequently worsen confusion and cause respiratory depression and falls in older adults, except in alcohol or sedative withdrawal, where they are the treatment. QT prolongation is a concern with haloperidol and other antipsychotics rather than benzodiazepines, benzodiazepines raise rather than lower the seizure threshold, and older adults are more sensitive to them, not less.

20. Korsakoff syndrome, which may follow untreated Wernicke encephalopathy, is characterized by:

    1. A. Fever and nuchal rigidity
    2. B. Visual hallucinations and tremor
    3. C. Ascending paralysis
    4. D. Memory loss with confabulation
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    Answer: D. Memory loss with confabulation

    Korsakoff syndrome causes severe anterograde amnesia with confabulation and results from chronic thiamine deficiency.

21. Which statement about dementia is correct?

    1. A. It always develops within weeks
    2. B. It is rapidly reversible
    3. C. It is not a normal part of aging
    4. D. It does not affect daily function
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    Answer: C. It is not a normal part of aging

    Although more common with age, dementia is a disease process that progressively impairs memory and daily functioning, not a normal consequence of aging.

22. Two days after surgery for a hip fracture, an 84-year-old is confused, inattentive and pulling at her lines. Before the fall she was sharp. What is the most likely explanation?

    1. A. Postoperative delirium
    2. B. Sudden-onset Alzheimer disease
    3. C. A primary psychiatric disorder
    4. D. Normal recovery from anesthesia
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    Answer: A. Postoperative delirium

    Delirium is very common in older adults after hip fracture surgery, triggered by pain, opioids and other drugs, sleep loss, infection and the stress of illness. It begins over hours to days with inattention and needs a search for treatable causes. Alzheimer disease develops over years, a new psychiatric disorder is unlikely at this age with clear triggers, and anesthesia effects wear off within hours.

23. A nursing home resident with dementia has become agitated over 3 days. She has not had a bowel movement in a week and her abdomen is firm and distended. What is the most likely cause of the change?

    1. A. Natural progression of her dementia
    2. B. Sundowning in the evening
    3. C. A new psychiatric illness
    4. D. Constipation triggering delirium
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    Answer: D. Constipation triggering delirium

    Constipation and fecal impaction are common, easily missed causes of agitation and delirium in older adults, especially those who cannot describe their discomfort. A change over days needs a search for a treatable cause rather than being blamed on dementia progression, which is slow. Sundowning follows a daily evening pattern, and a new psychiatric illness is unlikely when a clear physical cause is present.

24. A patient with dementia was reported missing and is found wandering in cold weather. Your assessment should include:

    1. A. Temperature and injuries
    2. B. A brief orientation check
    3. C. A detailed memory test
    4. D. A visual acuity check of each eye
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    Answer: A. Temperature and injuries

    A person with dementia who has wandered in the cold is at risk of hypothermia, falls and other injuries, so check the core temperature and do a full injury assessment. A brief orientation check is part of any assessment but does not address the cold exposure, a detailed memory test adds little in a patient with known dementia, and visual acuity testing does not address the main risks.

25. Which drug is commonly prescribed to patients with Alzheimer disease to slow symptom progression?

    1. A. Levodopa
    2. B. Phenytoin
    3. C. Donepezil
    4. D. Pyridostigmine
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    Answer: C. Donepezil

    Donepezil is a cholinesterase inhibitor used in Alzheimer disease; these drugs can cause bradycardia and syncope, a relevant field consideration.

26. An older woman with dementia and new urinary retention has a distended bladder and is agitated. Which statement is correct?

    1. A. Retention never affects behavior
    2. B. Retention can cause delirium
    3. C. This is normal dementia behavior
    4. D. She needs a sedative only
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    Answer: B. Retention can cause delirium

    Urinary retention, constipation, and pain are reversible causes of agitation and delirium in older adults.

27. In a busy hospital hallway with lights and alarms all night, an older patient awaiting admission becomes newly confused. Which simple measure can help prevent delirium?

    1. A. Protect sleep: less noise and light
    2. B. Give diphenhydramine to help her sleep
    3. C. Keep her awake to monitor her closely
    4. D. Keep the lights on so staff can see her
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    Answer: A. Protect sleep: less noise and light

    Sleep loss from noise, light and frequent interruptions contributes to delirium in older patients. Simple measures such as reducing noise and light at night, keeping glasses and hearing aids in place, and orienting the patient help prevent it. Diphenhydramine is anticholinergic and can cause delirium, and keeping her awake or the lights on worsens sleep loss.

28. A woman with moderate dementia who manages her own pills is drowsy with a heart rate of 44. Her weekly pill organizer has today's and tomorrow's slots empty. What is the most likely cause?

    1. A. A sudden worsening of her dementia
    2. B. Normal sleepiness in dementia
    3. C. Doubled doses from memory loss
    4. D. A new primary heart disease
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    Answer: C. Doubled doses from memory loss

    People with dementia often forget whether they have taken their medicines and may take extra doses, so an empty organizer slot ahead of schedule suggests an accidental overdose, here likely of a rate-slowing drug such as a beta blocker. Bring the organizer and bottles, and report the possible overdose. Dementia does not cause sudden bradycardia, the drowsiness is not normal for her, and primary heart disease is less likely with this clear clue.

29. Delirium in a hospitalized or nursing home patient is associated with:

    1. A. No effect on long-term outcome
    2. B. Lower risk of later dementia
    3. C. Harm mainly in hyperactive cases
    4. D. Increased mortality
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    Answer: D. Increased mortality

    Delirium is linked to higher mortality, longer stays, falls, and lasting cognitive decline, so early recognition matters. It raises rather than lowers the risk of later dementia, its effects can persist after the cause is treated, and the quiet hypoactive form carries an outcome at least as poor as the agitated form.

30. A hospice patient in her last days of life has become restless and confused. Her care plan focuses on comfort. What is the most appropriate approach?

    1. A. A full workup and transport for each cause
    2. B. Comfort care guided by her hospice team
    3. C. Restrain her to prevent falls at night
    4. D. Withhold her medicines to clear her mind
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    Answer: B. Comfort care guided by her hospice team

    Terminal delirium is common in the last days of life. Care should follow the patient's goals: look for simple, easily reversed causes such as pain, a full bladder or constipation, and contact the hospice team, which can guide medicines for comfort. An aggressive workup may not match her goals, restraints add distress, and stopping all medicines can cause pain or withdrawal.