The question bank is the fastest way to start, but PMHNP Helper also includes board-review planning, student resources, and plain-English guidance for psychiatric nurse practitioner students who are still learning the exam landscape.
A 72-year-old male is referred for psychiatric evaluation of suspected depression. His wife reports he has become increasingly apathetic and withdrawn over the past 8 months, with reduced spontaneous speech and loss of interest in hobbies. He has been falling frequently due to what she describes as a shuffling, wide-based gait that developed gradually. She also notes he has had several episodes of urinary incontinence over the past 3 months, which he attributes to not being able to reach the bathroom in time. On mental status examination, he is slow to respond, demonstrates psychomotor retardation, and scores 24/30 on the MMSE with deficits primarily in recall and executive function tasks. CT head reveals enlarged lateral ventricles out of proportion to the degree of cortical atrophy, with an Evans index of 0.35. Which of the following is the most likely diagnosis?
Explanation
Normal pressure hydrocephalus presents with the classic Hakim triad of gait disturbance (wide-based, magnetic, shuffling), cognitive impairment (subcortical pattern), and urinary incontinence in elderly patients. CT or MRI showing ventriculomegaly out of proportion to cortical atrophy (Evans index >0.3) is a key diagnostic finding. It is essential to identify because it is a potentially reversible cause of dementia.
Key Takeaway
The triad of wide-based shuffling gait, urinary incontinence, and subcortical cognitive impairment in an elderly patient with ventriculomegaly disproportionate to cortical atrophy should prompt evaluation for normal pressure hydrocephalus, a potentially reversible cause of dementia that can mimic depression.