American Board of Internal Medicine (ABIM) Certification Practice Exam

What characterizes the cognitive decline in Normal Pressure Hydrocephalus?

1. Memory loss only

2. Impaired attention and executive dysfunction

3. Speech difficulties alone

4. Rapid onset dementia

The correct answer is: Impaired attention and executive dysfunction

Normal Pressure Hydrocephalus (NPH) is characterized by a specific pattern of cognitive decline that includes impaired attention and executive dysfunction. This condition is often associated with a triad of symptoms known as Hakim's triad, which includes gait disturbances, urinary incontinence, and cognitive impairment. Cognitive changes in NPH are typically subtle at first but progress to significant impairment over time. Attention deficits are common, as individuals may struggle to concentrate and maintain focus. Executive dysfunction, which involves difficulties with planning, organizing, and initiating tasks, is also a hallmark of NPH. These cognitive changes can lead to significant challenges in daily functioning, making it difficult for individuals to perform familiar tasks or adapt to new situations. The other choices do not encapsulate the full spectrum of cognitive decline seen in NPH. For example, memory loss alone does not reflect the broader cognitive deficits seen in these patients. Similarly, if speech difficulties are prominent, they are not the primary characteristic of cognitive changes associated with NPH. Rapid onset dementia is also misleading, as the cognitive decline in NPH is generally more insidious rather than sudden and rapid in nature. Thus, the impairment in attention and executive function are core features that define the cognitive decline in Normal Pressure Hydro