A 65-Year-Old Woman Is Evaluated for Worsening Urinary Urgency and Incontinence

A 65-year-old woman is evaluated for worsening urinary urgency and incontinence.  The patient has had no abdominal pain, dysuria, or changes in urinary frequency.  On several occasions, she has urinated involuntarily, which she attributes to an inability to walk quickly to the bathroom.  The patient feels unsteady while ambulating and walks slowly with small steps.  Her family also reports that she has become forgetful and has difficulty planning and executing various activities that she used to perform regularly.  Medical history is notable for hypertension.  The patient does not use tobacco, alcohol, or illicit drugs.  Vital signs are within normal limits.  Cardiopulmonary, abdominal, and genitourinary examinations show no abnormalities.  Neurological examination shows impaired attention and short-term memory.  MRI of the brain reveals chronic white matter changes with no infarction, hemorrhage, or mass lesions.  There is diffuse ventriculomegaly with no sulcal enlargement.  Which of the following is the most likely underlying cause of this patient's urinary incontinence?

A) Cerebellar dysfunction
B) Compression of the reticular formation
C) Impaired basal ganglia signaling
D) Spinal cord damage
E) Stretching of descending cortical fibers

Correct Answer:

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