A 76-Year-Old Man Is Brought to the Office by His

A 76-year-old man is brought to the office by his family due to urinary incontinence.  The patient has a history of dementia and was placed in a skilled nursing facility a year ago after his family was unable to care for him at home.  He can indicate his needs but requires assistance for most activities of daily living.  During a recent visit, the patient's daughter noticed frequent episodes of involuntary dribbling of urine.  The nursing home staff confirms that the patient has had urinary incontinence for the past several days, but there is no report of fever, chills, vomiting, or blood in the urine.  The patient is unable to provide any additional information.  Medical history is notable for hypertension and osteoarthritis.  Temperature is 37.2 C (99 F) , blood pressure is 140/76 mm Hg, and pulse is 88/min.  He appears comfortable and is able to recognize his daughter but does not know the date or place.  Cardiopulmonary examination shows no abnormalities.  Abdominal examination reveals mild tenderness and fullness in the suprapubic region.  Application of manual pressure on the lower abdomen causes leakage of a small amount of clear urine.  The prostate is nontender but mildly enlarged and rubbery.  Which of the following is the most appropriate response to the family regarding this patient's urinary incontinence?

A) He should be evaluated for potentially reversible causes of urinary incontinence before initiating any intervention.
B) He should have a long-term urethral catheter to prevent skin breakdown and reduce the risk of infections.
C) His incontinence is most likely due to dementia-associated loss of the brain's control of the urinary bladder.
D) His urinary incontinence denotes that the most likely cause of the dementia is normal pressure hydrocephalus.
E) His urinary incontinence indicates that the dementia has progressed to a moderate to severe degree.