Normal Pressure Hydrocephalus Often Mistaken as Dementia

With the Baby Boomer generation reaching the ranks of the elderly, there’s a new consciousness of illness and health. This is an activist generation used to having the answers. That’s why it is of particular interest for us at Advanced Neurosurgery Associates (ANA) that recent news focuses on the mistaken diagnosis of dementia in the elderly when the cause of symptoms might just be hydrocephalus. This is a condition we treat extensively in our practice and we believe increased hydrocephalus awareness will prove beneficial.

According to an article in U.S. News & World Report Health, experts estimate that five to 10 percent of Americans diagnosed with dementia could actually have normal pressure hydrocephalus, a treatable condition.

An estimated 700,000 adults are living with normal pressure hydrocephalus (NPH), a disorder involving the abnormal increase of cerebrospinal fluid (CSF) that causes the brain cavities to become enlarged.

Normal pressure hydrocephalus occurs if the normal flow of CSF throughout the brain and spinal cord is blocked in some way. This causes the ventricles to enlarge, putting pressure on the brain. Normal pressure hydrocephalus can occur in people of any age, but it is most common in the elderly. It may result from a subarachnoid hemorrhage, head trauma, infection, tumor or complications of surgery. However, many people develop NPH even when none of these factors are present. In these cases, the cause of the disorder is unknown.

Regardless of the cause, symptoms of NPH often begin slowly and progress over time. Symptoms can include:

  • Gait or walking problems (shuffling of the feet, unsteadiness)
  • Problems controlling urine or stools (urinary or fecal incontinence)
  • Slowing of mental function, such as forgetfulness, difficulty paying attention and apathy

 

Now, it’s important to note that dementia is not a specific disease. It’s an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Because symptoms of NPH can fall under that umbrella, the disorder is often misdiagnosed.

 

In fact, many cases of NPH go unrecognized and are never properly treated. However, as we know at ANA, doctors may use a variety of tests, including brain scans (CT and/or MRI), a spinal tap or lumbar catheter, intracranial pressure monitoring and neuropsychological tests, to help them diagnose NPH and rule out other conditions.

 

Yet despite the availability of surgical treatment options, according to the Hydrocephalus Association in Bethesda, Maryland, the largest private funder of hydrocephalus research in the U.S., fewer than 20 percent of people with NPH receive an appropriate diagnosis.

 

Experts hope groundbreaking research through the Adult Hydrocephalus Clinical Research Network will lead to new diagnostic methods and better treatments for people with NPH. The network includes multiple clinical centers across the U.S. and Canada with a central center to coordinate data. In fact, an initiative for scientific studies was launched last year with a $500,000 startup grant from the Hydrocephalus Association.

 

With more accurate diagnostic measures and treatment plans, research suggests treating hydrocephalus in the elderly population would reduce U.S. health care expenditures by an estimated $200 million over five years, according to the Hydrocephalus Association.

 

Click here to read more on our treatments for hydrocephalus.