“Patient with Normal Pressure Hydrocephalus Regains Her Life After Family Feared She Had Alzheimer's ”
AUSTIN, TEXAS—In November 2008, doctors at NeuroTexas Institute at St. David’s HealthCare performed a life-changing procedure on a patient with normal pressure hydrocephalus (NPH), a treatable condition that can mimic Alzheimer’s and dementia. That patient—79-year-old Nancy Thompson—is now reaching a point of optimum results, and those results are a dramatic improvement on her former life.
“Before the procedure, I was lethargic,” Nancy Thompson said. “I could not participate in conversation and I shuffled when I walked, but I just thought it was part of aging.”
According to the Alzheimer’s Association, as many as 5.3 million people in the United States are living with Alzheimer’s, but medical experts estimate about 5 to 10 percent of them might actually be suffering from NPH. NPH affects about 375,000 Americans each year.
“This condition is often overlooked by many physicians and mistaken for a more serious condition, such as Alzheimer’s which is not treatable,” Mark Burnett, M.D., executive medical director at NeuroTexas Institute at St. David’s HealthCare, said. “However, NPH can be treated with surgery when properly diagnosed.”
NeuroTexas Institute at St. David’s HealthCare is conducting research on NPH.
According to the National Institute of Neurological Disorders and Stroke, NPH is an abnormal increase of cerebrospinal fluid in the brain's ventricles, or cavities. It occurs if the normal flow of cerebrospinal fluid 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 population.
Symptoms of NPH, which can occur gradually, include dementia, urinary incontinence and difficulty walking. A patient may have a general slowing of movements or may complain that his or her feet feel "stuck," causing them to walk with a “shuffle.” Doctors use a variety of tests to diagnose NPH, including brain CT and/or MRI scans. Symptoms usually worsen over time unless NPH is treated with surgery.
“During this procedure, we insert a programmable shunt, or tube, in the brain to drain the excess cerebrospinal fluid into the abdomen,” Dr. Burnett said. “The fluid is then absorbed, allowing the brain ventricles to return to their normal size. The results can be dramatic.”
While patients’ results will vary, most will see a significant improvement. The earlier NPH is diagnosed and treated, the better a patient’s chance of an optimal recovery.
“I feel like I’ve regained my independence,” Thompson said. “I can now walk (with only a cane due to impaired vision), and I can talk without difficulty.”
Regular follow-up care by a physician will help identify subtle changes that might indicate problems with the shunt. Additionally, doctors must slowly adjust the shunt pressure to find a patient’s “sweet spot.”
