Differential Diagnosis for a 78-year-old with Incontinence, Gait Changes, and Memory Difficulties

Single Most Likely Diagnosis

• Normal Pressure Hydrocephalus (NPH): This condition is characterized by the triad of gait disturbance, dementia, and urinary incontinence, which closely matches the patient's symptoms. The onset of symptoms over a year also fits within the timeframe for NPH.

Other Likely Diagnoses

• Alzheimer's Disease: While Alzheimer's primarily presents with memory difficulties, some patients may exhibit changes in gait and balance, as well as urinary incontinence, especially in advanced stages.
• Parkinson's Disease: Parkinson's can cause gait disturbances, including a forward-leaning posture, and cognitive decline. However, urinary incontinence is less commonly an early symptom.
• Vascular Dementia: This condition can result from a series of small strokes, leading to cognitive decline, gait disturbances, and potentially urinary incontinence, depending on the areas of the brain affected.

Do Not Miss Diagnoses

• Brain Tumor: Although less likely, a brain tumor could explain the combination of symptoms, especially if the tumor is located in an area that affects gait, bladder control, and cognitive function. Missing this diagnosis could be fatal.
• Subdural Hematoma: In elderly patients, even minor trauma can lead to a subdural hematoma, which may present with cognitive changes, gait disturbances, and incontinence. This is a medical emergency.
• Infections (e.g., Neurosyphilis, Lyme Disease): Certain infections can affect the central nervous system and cause a wide range of symptoms, including those described. These conditions require prompt diagnosis and treatment to prevent long-term damage.

Rare Diagnoses

• Progressive Supranuclear Palsy (PSP): A rare neurodegenerative disorder that can cause significant gait disturbance, including a tendency to fall, and cognitive decline. However, the full spectrum of PSP symptoms, including supranuclear ophthalmoplegia, would need to be considered.
• Corticobasal Degeneration: Another rare neurodegenerative disease that can cause gait disturbances, cognitive decline, and sometimes urinary incontinence, but it typically presents with more asymmetric motor symptoms.
• Multiple System Atrophy (MSA): A rare condition that can cause parkinsonian symptoms, gait disturbances, and autonomic dysfunction, including urinary incontinence. However, it usually presents with a combination of parkinsonian and cerebellar symptoms.