Certified Neuroscience Registered Nurse (CNRN) Practice Exam

Patients presenting with impaired memory, broad-based magnetic gait, and urinary incontinence display symptoms of which disorder, and what treatment is indicated?

1. Normal pressure hydrocephalus; treatment is VP shunt

2. Alzheimer's disease; treatment is cognitive therapy

3. Pseudodementia; treatment is antidepressants

4. Multisystem atrophy; treatment is dopaminergic therapy

The correct answer is: Normal pressure hydrocephalus; treatment is VP shunt

The correct answer reflects a condition known as normal pressure hydrocephalus (NPH), which is characterized by the classic triad of symptoms: cognitive dysfunction (such as impaired memory), gait abnormalities (often described as a broad-based magnetic gait), and autonomic dysfunction (such as urinary incontinence). These symptoms occur due to the accumulation of cerebrospinal fluid in the ventricles of the brain without a significant increase in intracranial pressure, hence the term "normal pressure". The most effective treatment for normal pressure hydrocephalus is the placement of a ventriculoperitoneal (VP) shunt. This surgical procedure diverts excess cerebrospinal fluid from the ventricles to the peritoneal cavity, thereby alleviating the symptoms. Patients often show significant improvement in their cognitive functions, gait, and urinary symptoms following this intervention. The other conditions described do not align as clearly with the specific symptom triad presented. Alzheimer's disease, while it may involve memory impairment, generally does not include the gait disturbances and incontinence characteristic of NPH. Similarly, pseudodementia, which is associated with depression, and multisystem atrophy, a neurodegenerative disorder with Parkinsonian features, do not encapsulate the full symptom pattern observed in