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100+ Free ABPN Geriatric Psychiatry Practice Questions

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Which cognitive domain is generally PRESERVED during normal aging?

A
B
C
D
to track
2026 Statistics

Key Facts: ABPN Geriatric Psychiatry Exam

~200

Total MCQ Items

ABPN Geriatric Psychiatry Subspecialty Exam

~4-5 hr

Total Exam Time

1-day computer-based test

~18-22%

Mood/Anxiety/Psychosis

Largest domain on 2026 ABPN Geriatric Psychiatry outline

$2,200

2026 Subspecialty Fee

ABPN initial subspecialty certification

1 yr

Fellowship Required

ACGME-accredited Geriatric Psychiatry fellowship

Pearson VUE

Test Delivery

Computer-based testing at authorized centers

The ABPN Geriatric Psychiatry subspecialty exam is a 1-day Pearson VUE CBT with ~200 single-best-answer MCQs over approximately 4-5 hours. The 2026 outline emphasizes Alzheimer disease and anti-amyloid therapy (~14-16%), other dementias (~12-14%), late-life mood/anxiety/psychosis (~18-22%), delirium (~8-10%), BPSD/caregiver (~8-10%), MCI/normal aging (~8-10%), falls/pain/capacity/end-of-life (~8-10%), substance/sleep (~6-8%), and long-term care/psychotherapy (~4-6%). The 2026 subspecialty fee is ~$2,200; requires primary ABPN Psychiatry + 1-year ACGME geriatric psychiatry fellowship.

Sample ABPN Geriatric Psychiatry Practice Questions

Try these sample questions to test your ABPN Geriatric Psychiatry exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which cognitive domain is generally PRESERVED during normal aging?
A.Processing speed
B.Crystallized intelligence (accumulated vocabulary and knowledge)
C.Episodic memory encoding of new information
D.Working memory capacity
Explanation: Normal cognitive aging is characterized by slowed processing speed, reduced working memory, and mild decline in episodic memory encoding. Crystallized intelligence (vocabulary, semantic knowledge, accumulated expertise) is preserved and may continue to grow into late life. Disproportionate decline outside these expected changes warrants evaluation for MCI or dementia.
2Which pharmacokinetic change in older adults MOST increases the volume of distribution of lipophilic drugs such as diazepam?
A.Increased hepatic phase I metabolism
B.Increased serum albumin
C.Increased body fat and decreased total body water
D.Increased glomerular filtration rate
Explanation: Aging increases the proportion of body fat and reduces total body water, enlarging the volume of distribution (Vd) of lipophilic drugs (diazepam, chlordiazepoxide) and prolonging their half-lives. Albumin falls (↑ free fraction of highly protein-bound drugs), hepatic phase I metabolism declines, and renal clearance decreases — all increasing drug effect and toxicity risk.
3Polypharmacy in older adults is commonly defined as the concurrent use of how many medications?
A.Ten or more medications
B.Two or more medications
C.Three or more medications
D.Five or more medications
Explanation: The most widely accepted operational definition of polypharmacy is concurrent use of ≥5 medications. It is associated with increased risk of adverse drug events, delirium, falls, and nonadherence. Routine review using Beers Criteria and STOPP/START is indicated at every geriatric visit.
4Which serum creatinine scenario is MOST likely to underestimate renal impairment in an elderly patient?
A.Elevated serum creatinine in a dehydrated child
B.Elevated serum creatinine in a muscular 40-year-old
C.Normal serum creatinine in a young athlete
D.Normal serum creatinine in a frail 85-year-old with reduced muscle mass
Explanation: Serum creatinine depends on muscle mass. Frail elderly patients with sarcopenia can have a 'normal' creatinine despite significantly reduced GFR. Always estimate renal function with Cockcroft-Gault or eGFR when dosing renally cleared drugs (lithium, gabapentin, memantine) in older adults.
5A decline in serum albumin in older adults primarily affects drug pharmacokinetics by:
A.Increasing renal excretion of acidic drugs
B.Increasing the free (unbound) fraction of highly protein-bound drugs
C.Decreasing absorption across the gut wall
D.Decreasing hepatic first-pass metabolism
Explanation: Reduced albumin in elderly patients increases the unbound (free, active) fraction of highly protein-bound drugs (e.g., valproate, warfarin, phenytoin). Although total drug levels may appear therapeutic, free drug effect is magnified, increasing toxicity risk.
6According to DSM-5-TR, which finding is REQUIRED for a diagnosis of major neurocognitive disorder due to Alzheimer disease (probable) without biomarker confirmation?
A.Early and prominent personality or behavioral change
B.Acute onset within 72 hours
C.Clear evidence of decline in memory and learning plus at least one other cognitive domain, with steadily progressive course and no mixed etiology
D.Fluctuating cognition with recurrent visual hallucinations
Explanation: DSM-5-TR probable major NCD due to AD requires evidence of decline in memory and learning plus at least one other cognitive domain, with a gradually progressive course and no evidence of mixed etiology. Acute onset suggests delirium or vascular; prominent early behavioral change suggests FTD; fluctuations with visual hallucinations suggest DLB.
7Which CSF biomarker profile is MOST consistent with Alzheimer disease?
A.Elevated CSF Aβ42 with low total tau
B.Low CSF Aβ42 with elevated total tau and phospho-tau
C.Low CSF Aβ42 with low total tau
D.Elevated CSF 14-3-3 protein and elevated RT-QuIC
Explanation: In AD, amyloid deposition in plaques reduces CSF Aβ42 while neurodegeneration releases tau, elevating total and phospho-tau. Elevated CSF 14-3-3 and RT-QuIC positivity support CJD. Plasma p-tau 217 is an emerging accessible blood biomarker for AD.
8Which cognitive screen is MORE sensitive than the MMSE for detecting mild cognitive impairment (MCI)?
A.Mini-Cog
B.Clock Drawing Test alone
C.Montreal Cognitive Assessment (MoCA)
D.Global Deterioration Scale (GDS)
Explanation: The MoCA (30 points) is more sensitive than the MMSE for MCI because it stresses executive function, visuospatial skills, attention, abstraction, and delayed recall. MMSE has ceiling effects in highly educated patients and underdetects frontal/executive dysfunction. GDS is a staging tool, not a screen.
9Which apolipoprotein E allele is the strongest common genetic risk factor for late-onset Alzheimer disease?
A.ApoE ε2
B.ApoE ε4
C.ApoE ε3
D.PSEN1 mutation
Explanation: ApoE ε4 is the most important common genetic risk factor for late-onset sporadic AD; ε4 homozygotes have the highest risk and earlier age of onset. ApoE ε2 is protective. PSEN1, PSEN2, and APP mutations cause autosomal dominant early-onset familial AD.
10A 76-year-old with mild AD is started on donepezil. Which titration is most appropriate?
A.Start 23 mg daily for mild disease
B.Start 10 mg daily immediately
C.Start 5 mg daily for 4-6 weeks, then increase to 10 mg daily if tolerated
D.Start 2.5 mg every other day indefinitely
Explanation: Donepezil is initiated at 5 mg daily and titrated to 10 mg daily after 4-6 weeks to minimize GI side effects (nausea, diarrhea, anorexia). The 23 mg dose is indicated only for moderate-to-severe AD already on 10 mg ≥3 months. Cholinergic side effects include bradycardia, syncope, and nightmares.

About the ABPN Geriatric Psychiatry Exam

The ABPN Geriatric Psychiatry Subspecialty Examination is the certifying exam for psychiatrists who have completed primary ABPN Psychiatry certification and an ACGME-accredited 1-year Geriatric Psychiatry fellowship. The 1-day computer-based exam delivers approximately 200 single-best-answer MCQs covering normal vs abnormal aging and geriatric pharmacokinetics, Alzheimer disease (DSM-5-TR, biomarkers — amyloid PET/CSF/plasma p-tau 217, MMSE vs MoCA, cholinesterase inhibitors, memantine, anti-amyloid monoclonal antibodies lecanemab and donanemab with ARIA monitoring, brexpiprazole FDA-approved for AD agitation), Lewy body dementia and antipsychotic hypersensitivity, frontotemporal dementia, vascular cognitive impairment, MCI, delirium and anticholinergic burden, late-life depression/anxiety/bipolar/psychosis, substance use, sleep (insomnia, RBD), BPSD, falls, capacity, suicide risk, end-of-life and palliative psychiatry, long-term care regulations (OBRA 1987), and psychotherapy adapted for older adults.

Questions

200 scored questions

Time Limit

1-day CBT (~4-5 hours)

Passing Score

Criterion-referenced scaled score set by ABPN (modified Angoff)

Exam Fee

~$2,200 subspecialty certification fee (ABPN 2026) (American Board of Psychiatry and Neurology (ABPN) / Pearson VUE)

ABPN Geriatric Psychiatry Exam Content Outline

~14-16%

Alzheimer Disease & Anti-Amyloid Therapy

DSM-5-TR major NCD due to AD; biomarkers — amyloid PET, CSF Aβ42 low/tau high, plasma p-tau 217; MMSE vs MoCA (MoCA more sensitive for MCI); GDS and CDR staging; ApoE ε4 risk allele. Cholinesterase inhibitors: donepezil (5→10 mg titration; 23 mg for severe), rivastigmine patch (preferred in hepatic dz, GI tolerability), galantamine. Memantine (NMDA mod) for moderate-severe or combination. Anti-amyloid monoclonal antibodies: lecanemab (FDA 2023 for MCI/mild AD; biweekly IV; MRI ARIA-E edema and ARIA-H microhemorrhage monitoring at baseline and serial; ApoE ε4 homozygotes highest ARIA risk; contraindicated with concurrent anticoagulation) and donanemab (2024). Brexpiprazole FDA-approved 2023 for agitation in AD. Antipsychotic black-box mortality warning in dementia.

~12-14%

Other Dementias

Vascular cognitive impairment (stepwise, subcortical ischemic, executive dysfunction). Lewy body dementia — REM sleep behavior disorder, fluctuating cognition, recurrent visual hallucinations, parkinsonism, ANTIPSYCHOTIC HYPERSENSITIVITY (avoid typicals; rivastigmine preferred; quetiapine or clozapine low-dose if psychosis requires treatment; pimavanserin FDA-approved for PDD only). Parkinson disease dementia. Frontotemporal dementia — behavioral variant (disinhibition, apathy, hyperorality) vs primary progressive aphasia (semantic, nonfluent, logopenic). CJD (rapidly progressive, myoclonus, CSF 14-3-3, MRI cortical ribboning/pulvinar sign in variant). NPH (gait > cognition > urinary; Evans index; LP response predicts shunt). HIV-associated neurocognitive disorders (HAND).

~18-22%

Late-Life Mood, Anxiety, Bipolar & Psychosis

Late-life depression — GDS screening, atypical presentation (somatic, anxiety, cognitive/pseudodementia), vascular depression hypothesis. First-line SSRIs: sertraline, escitalopram preferred; citalopram max 20 mg/day >60 yr (QTc risk); avoid paroxetine (anticholinergic). SNRIs (duloxetine also for pain), mirtazapine (appetite/sleep), bupropion. ECT highly effective in elderly (catatonia, psychotic depression, severe/suicidal). TMS, esketamine cautiously. Augmentation — lithium target ≤0.8, aripiprazole, quetiapine XR. Late-life anxiety — first episode warrants medical workup; avoid chronic benzodiazepines (Beers). Late-onset mania >50 yo — workup secondary causes (stroke, TBI, substance, medication); narrower lithium range 0.4-0.8. Very-late-onset schizophrenia-like psychosis (>60 yr, hearing/vision loss risk). Pimavanserin for PDD. Brexpiprazole for AD agitation.

~8-10%

Delirium & Anticholinergic Burden

Delirium superimposed on dementia common; CAM and CAM-ICU; hyperactive vs hypoactive (hypoactive more common, underdiagnosed). Anticholinergic burden — avoid diphenhydramine, amitriptyline, hydroxyzine, oxybutynin (Beers list). Postoperative delirium (hip fracture high-risk). Benzodiazepine-induced delirium in elderly. Treatment: identify and correct underlying cause; low-dose haloperidol (0.25-0.5 mg) PRN; quetiapine preferred in PD/DLB; AVOID benzodiazepines except for alcohol or BZD withdrawal; nonpharmacologic orientation, sleep hygiene, sensory aids.

~8-10%

MCI & Normal vs Abnormal Aging

Cognitive aging — processing speed and episodic memory decline; crystallized intelligence preserved. Physiological — reduced renal clearance (creatinine misleading — use Cockcroft-Gault/eGFR), increased body fat (↑ Vd lipophilic drugs — diazepam, long half-life), decreased hepatic phase I, albumin decline (↑ free drug fraction). Polypharmacy defined ≥5 medications. MCI types — amnestic vs nonamnestic, single vs multiple domains; 10-15%/year conversion to dementia. Anti-amyloid therapy only for early MCI/mild AD with documented amyloid. Reversible causes screen — B12, folate, TSH, depression pseudodementia, OSA, medications.

~8-10%

Agitation, BPSD & Caregiver

BPSD non-pharmacologic first — environmental modification, reminiscence, music therapy, caregiver education, routine. Trigger assessment — pain, constipation, UTI, dehydration, delirium, sensory impairment, unmet needs. Pharmacologic: brexpiprazole FDA 2023 for AD agitation; citalopram (CitAD trial); off-label antipsychotics with black-box mortality; trazodone; carbamazepine; memantine modest. Avoid benzodiazepines except acute. Zarit Burden Scale for caregiver burden; respite and support groups. Elder abuse types (physical, emotional, financial, sexual, neglect); mandated reporting laws vary by state; caregiver depression screening.

~8-10%

Falls, Pain, Capacity & End-of-Life

Fall risk ↑ with benzodiazepines, Z-drugs, sedating antipsychotics, TCAs; Beers list, STOPP/START criteria, vitamin D supplementation. Chronic pain — nortriptyline preferred over amitriptyline (less anticholinergic), duloxetine, gabapentinoids (caution — falls, edema), opioid cautions. Capacity: MacArthur Competence Tool — 4 components (understand, appreciate, reason, communicate); financial and testamentary capacity distinct. Advance directives, DPOA, POLST/MOLST. Prolonged grief disorder DSM-5-TR (>12 months). Suicide — highest completed rates white males ≥85 yo; firearm access and means restriction; SAFE-T framework. Palliative/hospice criteria; psilocybin research end-of-life distress.

~6-8%

Substance Use & Sleep Disorders

Alcohol use disorder — AUDIT, CAGE, SHORT MAST-G; ≥1 drink/day men, ≥0.5/day women considered problematic in elderly; age-related sensitivity (decreased total body water — higher BAL). Benzodiazepine dependence — Beers avoid chronic, slow taper. Opioid use and SBIRT. Insomnia — CBT-I first-line; low-dose trazodone, doxepin 3-6 mg FDA-approved geriatric insomnia, ramelteon (MT1/MT2 agonist), suvorexant/lemborexant (DORAs). OSA — STOP-BANG screen. REM sleep behavior disorder — alpha-synucleinopathy prodrome — melatonin 3-12 mg, clonazepam 0.25-1 mg.

~4-6%

Long-Term Care & Psychotherapy

Nursing home OBRA 1987 (Omnibus Budget Reconciliation Act) — limitations on chemical and physical restraints; Minimum Data Set (MDS) standardized assessment. Program of All-inclusive Care for the Elderly (PACE). Assisted living, memory care, home-based services, palliative/hospice. Psychotherapy in geriatrics — IPT (role transitions — retirement, widowhood, bereavement), CBT adapted for cognitive impairment, problem-solving therapy (PST), reminiscence therapy and life review, Coping With Depression (CWD) course for older adults.

How to Pass the ABPN Geriatric Psychiatry Exam

What You Need to Know

  • Passing score: Criterion-referenced scaled score set by ABPN (modified Angoff)
  • Exam length: 200 questions
  • Time limit: 1-day CBT (~4-5 hours)
  • Exam fee: ~$2,200 subspecialty certification fee (ABPN 2026)

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

ABPN Geriatric Psychiatry Study Tips from Top Performers

1Lewy body dementia ANTIPSYCHOTIC HYPERSENSITIVITY is a life-threatening pitfall. Giving a typical antipsychotic (haloperidol) or even a high-potency atypical can cause severe parkinsonism, NMS-like reactions, or sudden death. Suspect DLB whenever a patient has REM sleep behavior disorder + fluctuating cognition + visual hallucinations + parkinsonism. Treat cognition/psychosis with a cholinesterase inhibitor (rivastigmine preferred); if antipsychotic necessary use very low-dose quetiapine or clozapine. Pimavanserin is FDA-approved ONLY for Parkinson disease psychosis, not dementia generally.
2Anti-amyloid monoclonal antibodies (lecanemab, donanemab) require careful candidate selection and monitoring. Indicated ONLY in confirmed amyloid-positive MCI or mild AD (amyloid PET or CSF). Genotype ApoE ε4 FIRST — homozygotes have the highest ARIA risk. Contraindicated with concurrent anticoagulation (increased macrohemorrhage risk). Baseline MRI and serial MRIs (typically before doses 5, 7, and 14 for lecanemab) to screen for ARIA-E (edema) and ARIA-H (microhemorrhage/siderosis). Hold/stop based on severity. Not for moderate-severe AD.
3Beers Criteria elderly to AVOID: diphenhydramine and other sedating antihistamines (anticholinergic), tricyclic antidepressants (amitriptyline — high anticholinergic; nortriptyline less so and sometimes used for pain), long-acting benzodiazepines (diazepam), all benzodiazepines chronic use in elderly (fall and delirium risk), Z-drugs chronic, oxybutynin (anticholinergic — use mirabegron), skeletal muscle relaxants, megestrol, sliding-scale insulin. STOPP/START is a complementary screen for inappropriate prescribing and omission of indicated therapy.
4Citalopram max 20 mg/day for age >60 yr due to QTc prolongation risk. Escitalopram 10-20 mg and sertraline are generally preferred SSRIs in elderly. Avoid paroxetine (most anticholinergic SSRI, short half-life withdrawal). Fluoxetine has a very long half-life — problematic if drug changes needed. Duloxetine doubles as antidepressant and analgesic (diabetic neuropathy, chronic musculoskeletal pain). Mirtazapine is useful when appetite stimulation and sedation are desired. ECT is highly effective for elderly depression (catatonia, psychotic depression, severe/suicidal) and often safer than prolonged antidepressant trials.
5Brexpiprazole (FDA 2023) is the first agent specifically FDA-approved for agitation associated with Alzheimer dementia. It still carries the antipsychotic black-box mortality warning in dementia. Non-pharmacologic strategies remain first-line — identify triggers (pain, constipation, UTI, dehydration, delirium, unmet needs, sensory impairment), modify environment, use reminiscence/music therapy, and educate caregivers. Citalopram showed benefit in the CitAD trial for agitation in AD but must respect the ≤20 mg/day limit in elderly due to QTc.

Frequently Asked Questions

What is the ABPN Geriatric Psychiatry subspecialty exam?

The ABPN Geriatric Psychiatry Subspecialty Certification Examination is a 1-day computer-based test administered by the American Board of Psychiatry and Neurology at Pearson VUE test centers. It certifies psychiatrists who have completed primary ABPN Psychiatry certification followed by a 1-year ACGME-accredited Geriatric Psychiatry fellowship. The exam contains approximately 200 single-best-answer MCQs assessing knowledge of normal and abnormal aging, dementias (including anti-amyloid therapy), delirium, late-life mood and psychotic disorders, BPSD, substance use, sleep, capacity, and end-of-life psychiatry.

Who is eligible to take the ABPN Geriatric Psychiatry exam?

Candidates must hold a current ABPN Psychiatry primary certification in good standing and must have satisfactorily completed a 1-year ACGME-accredited Geriatric Psychiatry fellowship. A valid unrestricted medical license is required at the time of examination, along with fellowship program director attestation. Applications are submitted through the ABPN website within the designated eligibility window.

What is the format of the exam?

The subspecialty exam is a 1-day computer-based test at Pearson VUE, consisting of approximately 200 single-best-answer multiple-choice questions delivered over roughly 4-5 hours including a break. Questions often feature clinical vignettes with medication lists, cognitive test scores, neuroimaging, and labs. Content spans Alzheimer and non-Alzheimer dementias, anti-amyloid monoclonal antibody therapy, delirium, late-life mood and psychotic disorders, BPSD, substance use, sleep, falls/capacity, and end-of-life.

How much does the 2026 ABPN Geriatric Psychiatry exam cost?

The 2026 ABPN subspecialty certification fee for Geriatric Psychiatry is approximately $2,200. Cancellation and refund policies follow the ABPN schedule with decreasing refunds as the exam date approaches. Continuing Certification (MOC) includes annual self-assessment activities and a 10-year recertification cycle, each with associated fees. Retakes within the eligibility window require full re-registration and fee payment.

When is the exam administered?

The ABPN Geriatric Psychiatry subspecialty exam is typically offered once per year in an annual testing window. Applications open several months in advance with a submission deadline before the window. Candidates schedule specific Pearson VUE appointments after application approval. Exact 2026 dates should be confirmed on the ABPN Geriatric Psychiatry page.

How is the exam scored?

ABPN uses a criterion-referenced scaled scoring system with a passing standard set by subject-matter experts using the modified Angoff method. Pass/fail status depends on performance relative to the fixed cut-score rather than on other test-takers. Score reports include subdomain performance to guide future study. Results are typically released several weeks after the testing window closes.

What are the highest-yield topics?

Highest-yield topics include: Alzheimer disease diagnostic criteria and biomarkers (MMSE/MoCA, amyloid PET, CSF, plasma p-tau 217); anti-amyloid monoclonal antibody therapy — lecanemab and donanemab with ARIA-E/H MRI monitoring and ApoE ε4 genotyping; brexpiprazole FDA-approved 2023 for agitation in AD; Lewy body dementia with antipsychotic hypersensitivity (avoid typicals, prefer rivastigmine; pimavanserin for PDD only); delirium and anticholinergic burden (Beers list); late-life depression (SSRIs preferred — citalopram max 20 mg >60 yr for QTc; ECT efficacy); antipsychotic black-box mortality warning in dementia; suicide risk in elderly (white males ≥85); capacity assessment; OBRA 1987 nursing home regulations.

How should I study for ABPN Geriatric Psychiatry?

Use a 6-12 month focused plan during and after the 1-year fellowship. Map studies to the ABPN content outline: lead with Alzheimer disease and anti-amyloid therapy, then non-AD dementias, delirium, late-life mood/anxiety/bipolar/psychosis, BPSD and caregiver, substance and sleep, falls/pain/capacity/end-of-life, and long-term care and psychotherapy. Core resources include the American Psychiatric Publishing Textbook of Geriatric Psychiatry, the AAGP Geriatric Psychiatry Review and Exam Preparation Tool, DSM-5-TR, the AGS Beers Criteria, and recent 2023-2024 FDA labels for lecanemab, donanemab, and brexpiprazole in AD agitation. Drill MCQs and complete 1-2 timed full-length mock exams.