Atypical Neuropsychiatric Symptoms in the Elderly

Neurologic and psychiatric symptoms are common in geriatric patients, as exemplified by depression and dementia, which affect 10-15%1 and 6%2 of elderly persons, respectively. Often, such symptoms will represent primary neurologic or psychiatric syndromes, but clinicians must be aware that neuropsychiatric symptoms may also be secondary to other medical illnesses, medications, or metabolic abnormalities, and may present in varied and unusual ways. This article examines atypical neuropsychiatric symptoms that are secondary to medical or other causes. Our goal is to introduce the clinician to several causes of such symptoms, and to reinforce the principle that when neuropsychiatric symptoms emerge in the elderly, it is clinically imperative that a wide differential diagnosis be considered in symptom evaluation. Five cases are presented here that exemplify the evaluation of medication side effects, psychosis, movement disorders, depression, and anxiety in the elderly person.