Certified Neuroscience Registered Nurse (CNRN) Practice Exam

Dementia with a temporal step-wise clinical progression is most likely due to which condition?

1. Normal pressure hydrocephalus

2. Vascular dementia

3. Alzheimer's disease

4. Frontotemporal dementia

The correct answer is: Vascular dementia

Vascular dementia is characterized by a temporal step-wise clinical progression due to the nature of its underlying pathology, which involves changes in blood flow to the brain. This can result from strokes or transient ischemic attacks (TIAs) that lead to the death of brain cells. Patients often experience sudden changes in cognitive function, followed by periods of relative stability, creating the step-wise progression typical of this form of dementia. In addition to this, vascular dementia can frequently coexist with other types of dementia, making its recognition crucial for appropriate management. This condition's progression stands in contrast to other dementias, such as Alzheimer's disease, which typically follows a more gradual decline, and frontotemporal dementia, which often involves more pronounced changes in behavior and language before cognitive decline. Normal pressure hydrocephalus might also present with progressive symptoms, but its clinical picture includes characteristic triad symptoms of gait disturbance, urinary incontinence, and cognitive decline, making it less aligned with a step-wise progression seen in vascular dementia.