Is it Alzheimer’s or NPH?

A lot of people with Normal Pressure Hydrocephalus (NPH) are misdiagnosed and told that they have either Alzheimer’s or Parkinson’s. The Hydrocephalus Association estimates that at least 350,000 Americans and 5 percent of people with dementia have NPH. A 3005 Virginia Commonwealth University paper estimates that 9 percent of patients in assisted-living facilities may have NPH.

Normal pressure hydrocephalus (NPH) is a rise in cerebrospinal fluid (CSF) in the brain that affects brain function. However, the pressure of the fluid is usually normal. Hydrocephalus means "water on the brain."

The root cause of NPH is unknown. As CSF fluid builds up in the brain, the fluid-filled chambers (ventricles) of the brain swell. This causes pressure on brain tissue. This can damage or destroy parts of the brain.

The symptoms often begin slowly and some people may consider it just part of the aging process.

A person needs to have three symptoms to be diagnosed with Normal Pressure Hydrocephalus:

• Changes in the way a person walks: difficulty when beginning to walk (gait apraxia), feet held wider apart than normal, shuffling of the feet, unsteadiness
• Slowing of mental function: forgetfulness, difficulty paying attention, apathy or no mood
• Problems controlling urine (urinary incontinence), and sometimes controlling stools (fecal incontinence)

Sudden falls without a loss of consciousness or other symptoms (drop attacks) may occur early in the illness.

Note: Many of these symptoms are common in the elderly, and may be caused by other conditions. NPH normally occurs in people 55 or older.

An examination shows walking (gait) changes related to the pressure placed on parts of the brain. Deep tendon reflexes may be increased in the lower legs.

Tests include Lumbar puncture (spinal tap) with careful testing of walking before and after the spinal tap and a Head CT scan or MRI of the head.

The good news is that NPH can be treated by surgery to reduce pressure in the brain. The treatment of choice is surgery to place a tube called a shunt that routes the excess CSF out of the brain ventricles. This procedure is successful in 85 – 90 percent of NPH patients.

Call your doctor if you or a loved one is having increasing problems with memory loss, walking, and urine incontinence.

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