Lesser known NPH mimics Alzheimer's but is reversible

Leslie Sykes Image
Wednesday, May 23, 2018
Lesser known NPH mimics Alzheimer's but is reversible
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A disorder called NPH can produce symptoms similar to Alzheimer's or Parkinson's but is treatable.

Imagine if you, or a loved one suddenly started to experience memory loss and started walking or moving differently.

These are all symptoms that point toward a diagnosis of Parkinson's or Alzheimer's. But you might be suffering from something else, called NPH, which mimics these diseases - yet it's reversible.

Seventy-year old Betty Smith has plenty of energy; she's active and every day takes her rescue dogs Holly and Oliver on long walks.

But a little more than two years ago, her family noticed she was having trouble walking.

Betty's sister-in-law, Sandi Smith, noticed the odd movement Betty was making. Sandi Smith said, "We called it a waddle to begin with. She just seemed to kind of waddle."

Then Betty began to fall whenever she changed directions. A neighbor had been diagnosed with Parkinson's, one of Betty's worst fears.

"She had a very bright mind trapped in a body that couldn't function," Betty recalled.

Dr. Manoucher Manoucheri is an internal medicine specialist and is the director of the NPH Program at Florida Hospital.

"It is critical to diagnose NPH early; it is the only reversible condition you can actually help the patient with," Manoucheri said.

NPH, or normal pressure hydrocephalus, is a buildup of cerebral spinal fluid in the brain's cavities. Cerebrospinal fluid is a clear, colorless fluid that bathes the brain and spinal cord. Normally, the fluid circulates around the brain and is reabsorbed. But if the patient is unable to reabsorb the fluid, then it accumulates.

Besides the memory issues, and impaired bladder control, there's another more tell-tale symptom; a shuffling gait. Or a walk that, in Betty Smith's case, was described more as waddling.

To treat NPH surgeons implant a shunt which slowly drains excess fluid from the brain, lowering the pressure.

"It is basically a tube placed in the ventricle and subcutaneously goes into peritoneal cavity," Manoucheri explained.

In addition to the shunt, NPH patients may also have a neuropsychiatric evaluation and physical therapy.

For some patients, like Betty, when the pressure is gone they begin to recover. And recovery can happen relatively quickly - some even see improvement in a week.

A few months after surgery, Betty traveled to Budapest with a friend and visited her sister-in-law in Alaska.

The complete reversal brought Betty and her family great relief.

"It's this big smile on my face," she said. "I've had my own personal miracle. I'm very, very blessed."

Manoucheri says with early diagnosis, many patients have their symptoms reversed. Unfortunately, because the symptoms of NPH, like cognitive issues and balance issues, mimic those found in Parkinson's and Alzheimer's patients, it's often overlooked or misdiagnosed.

But if NPH is not treated, it can worsen, and may cause death.

In about half of the cases, a brain injury, caused by infection or trauma, is the cause of the fluid buildup.


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