NPH Often Mistakenly Diagnosed As Alzheimer's

Dorian Martin Health Guide
  • One of Sunday’s tasks is reading multiple newspapers to see what’s going on in the world. By habit, I always check the circular sections first before heading to the hard news section. Therefore, one of the first sections I read is Parade Magazine.

    The November 11, 2012 issue was especially of note. It wasn’t because of the Thanksgiving recipes offered by the television hosts of "The Chew" (although those were of interest). The article that really got my attention was entitled “What If Grandpa Doesn’t Really Have Alzheimer’s?” In it, reporter Joanne Chen recounts the experiences of Jimmy Nowell.  Working as a salesman, he was always able to help his customers and provided excellent service. However, in 2000 when he was 59 years old, Nowell began to have trouble with speaking and walking. He eventually became disorganized. Five years after these symptoms emerged, he lost his job as a result of his behavior. Two years later, he couldn’t remember his wife’s name.  Nowell went to several doctors, but wasn’t able to get a diagnosis that all of the doctors agreed with. One pegged his malady as Parkinson’s disease while another thought it was Alzheimer’s. Finally, in 2009, a neurologist was able to correctly diagnosis what was going on after taking an MRI and comparing it to a baseline image that had been taken several years prior. The diagnosis: normal pressure hydrocephalus, also known as NPH.

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    So what is NPH? According to the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health, NPH is actually an abnormal increase of cerebrospinal fluid in the brain’s ventricles that happens if the normal flow of this fluid throughout the brain and spinal cord becomes blocked. This blockage causes the ventricles to swell, therefore putting pressure on the brain. While NPH is more common in the elderly, it actually can occur in people at any stage of life. The National Hydrocephalus Foundation points out some people are diagnosed with this condition when they are in their 30s. NINDS stated that this condition seems to result most often from a hemorrhage, head trauma, infection, tumor, or complications after surgery. However, some people actually develop NPH without any of these factors.

    Symptoms of this condition include impaired bladder control that can show up as urinary frequency and incontinence, issues with walking and movement, and progressive cognitive impairment, including dementia. “Because these symptoms are similar to those of other disorders such as Alzheimer's disease, Parkinson's disease, and Creutzfeldt-Jakob disease, the disorder is often misdiagnosed,” the NINDS website states. “Many cases go unrecognized and are never properly treated.” Tests that may be used to identify NPH include brain scans, a spinal tap, intracranial pressure monitoring and neuropsychological tests. Chen reported that the Hydrocephalus Association has estimated that approximately 350,000 Americans as well as five percent of people with dementia actually have NPH.

  • It’s important to get a diagnosis and treatment since the symptoms of this condition will, in most cases, worsen over time. Treatment consists of placing a stunt in the brain in order to drain the excessive cranial fluid into the abdomen so that this fluid can be absorbed. This drainage actually allows the brain ventricles to return to normal. “Depending on the patient, symptoms should improve over time,” the National Hydrocephalus Foundation website states. “Some symptoms disappear almost immediately, while other improvements take a bit longer. Occasionally, the doctor will order some physical and/or occupational therapy.” People with this condition need to remain in regular contact with their physician so that any subtle changes can be identified that indicate that there are problems with the shunt.

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    So what happened to Nowell? He had a shunt inserted in his skull and was soon able to walk without a cane. “When his wife stepped off the elevator, he called out her name without hesitation, and she cried with joy,” Chen reported. “Jimmy was back.”

    Primary Sources for This Sharepost:

    Chen, J. (2012). What if grandpa doesn’t really have Alzheimer’s? Parade.

    National Hydrocephalus Foundation. (nd). Normal pressure hydrocephalus.

    National Institute of Neurological Disorders and Stroke. (2012). NINDS normal pressure hydrocephalus information page. National Institutes of Health.

Published On: November 13, 2012