American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a common nondegenerative cause to consider in dementia diagnosis when ordering a structural neuroimaging study?

1. Absence seizures

2. Subdural hematoma

3. Sleep apnea

4. Anxiety disorders

The correct answer is: Subdural hematoma

Subdural hematoma is a significant nondegenerative cause to consider when diagnosing dementia and warrants a structural neuroimaging study. This condition can occur due to trauma, often in older adults who may not even recall a specific injury. The accumulation of blood between the skull and the brain can lead to various neurological symptoms, including cognitive decline, memory issues, and changes in personality, which can mimic or exacerbate dementia. In the context of suspected dementia, neuroimaging, such as a CT scan or MRI, is critical to identify any structural abnormalities like subdural hematomas. Early identification of this condition is particularly important because it can sometimes be treated effectively through surgical intervention, potentially reversing cognitive deficits. The other options, while they might have implications in cognitive functioning, do not typically present as structural abnormalities detectable on neuroimaging in the same way. Absence seizures primarily affect consciousness and can lead to confusion but are not seen on neuroimaging in a structural fashion. Sleep apnea can result in cognitive issues due to intermittent hypoxia but is more a functional issue rather than a structural one, and anxiety disorders do not cause the same structural changes in the brain that would be visible on imaging.