Why Is Nph So Rarely Diagnosed
Normal pressure hydrocephalus is already “vastly underdiagnosed” overall, says Alexandra Golby, MD, professor of neurosurgery and radiology at Harvard Medical School. Some neurologists don’t believe in the condition, she notes, which helps explain why it isn’t diagnosed more often. But it’s also obscured behind symptoms like dementia, mobility issues, and urinary incontinence, which are already common in older patients.
“Those symptoms seem like the kinds of things that happen to older people. The patients themselves think, ‘This must be old age,'” Dr. Golby says. “Their families think that, and their primary care physicians often don’t put it together. It also can have an insidious presentation, and it can sneak up on people like old age does.”
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Even when people do seek treatment for their symptoms, she adds, NPH is commonly misdiagnosed by primary care physicians who lack familiarity with the condition they may instead blame dementia on Alzheimer’s or gait deviations on Parkinson’s. Patients with NPH often visit several doctors before they hear anything about hydrocephalus.
“By the time patients get to me as a surgeon, they’ve often gone through many layers of care,” Dr. Golby says. Some do come in without a referral, though, after learning about NPH on their own. “They look on the internet because they’re frustrated with the lack of progress, and they self-refer,” she says. “And that’s great when that happens.”
What Are The Causes Of Lewy Body Dementia
The precise cause of LBD is unknown, but scientists are learning more about its biology and genetics. For example, we know that an accumulation of Lewy bodies is associated with a loss of certain neurons in the brain that produce two important chemicals that act as messengers between brain cells . One of these messengers, acetylcholine, is important for memory and learning. The other, dopamine, plays an important role in behavior, cognition, movement, motivation, sleep, and mood.
Scientists are also learning about risk factors for LBD. A risk factor is something that may increase the chance of developing a disease. Some risk factors can be controlled while others cannot. Age is considered the greatest risk factor. No specific lifestyle factor has been proven to increase one’s risk for LBD.
Other known risk factors for LBD include certain diseases and health conditions, particularly Parkinson’s disease and REM sleep behavior disorder, which have been linked to a higher risk of LBD.
Having a family member with LBD also may increase a person’s risk, though LBD is not considered a genetic disease. Variants in three genes APOE, SNCA, and GBA have been associated with an increased risk, but in most cases, the cause is unknown.
Going For An Assessment
The list of conditions and problems above isnt everything. Theres a whole range of things that can occasionally cause dementia-like symptoms for some people.
There isnt always a quick answer to the question, Is it dementia or something else? If someone has dementia-like symptoms, the most important thing to do is see their GP for a full assessment.
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Top 6 Conditions That Are Commonly Misdiagnosed As Alzheimers Disease
February 9, 2021
When a grandparent or parent becomes forgetful, it may be tempting to associate this type of behavior with Alzheimers disease or another form of dementia. Although memory loss and poor judgement are symptoms of Alzheimers, there are a large number of conditions that share these symptoms. From Delirium, Normal Pressure Hydrocephalus, to Mild Cognitive Impairment, the source of your parents poor recollection may not be related to dementia. To help you determine the source of your family members memory issues, we have compiled a list of conditions that are commonly misdiagnosed as Alzheimers disease.
Conditions With Symptoms Similar To Dementia
Remember that many conditions have symptoms similar to dementia, so it is important not to assume that someone has dementia just because some of the above symptoms are present. Strokes, depression, excessive long-term alcohol consumption, infections, hormonal disorders, nutritional deficiencies and brain tumours can all cause dementia-like symptoms. Many of these conditions can be treated.
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Frontotemporal Dementia Versus Alzheimers Disease
AD is the most common dementia in older people. Therefore, it is often one of the first diseases a doctor considers. But Alzheimers disease usually begins with memory loss, while FTD is typically a behavior or language disorder.
- The probability of AD is strongly affected by the age of the person showing the symptoms. The odds of having Alzheimers disease increase markedly the older you get, while the odds for FTD may decrease with age.
- FTD often begins with distinct behavioral changes while people with Alzheimers disease in the early stages tend to remain socially skillful despite their memory problems . In advanced AD, people generally have trouble managing their finances, show poor judgment and irritability, and may become equally difficult to manage as people with FTD.
- Apathy in AD patients is milder, whereas apathy in FTD patients is more pervasive and more often reflects a lack of concern for others or lack of initiative.
- People with AD usually have an early and profound difficulty learning and retaining new information. As the disease progresses, memory for new and old information is lost. These memory problems may lead to language problems as well, but the root is a problem remembering. In contrast, most mildly impaired FTD patients generally know the day or time and their location, and they are able to keep track of recent events. They may not test well, but that may be due to lack of concern or effort in the testing situation.
Behavioral And Mood Symptoms Of Lewy Body Dementia
Changes in behavior and mood are possible in LBD and may worsen as the persons thinking abilities decline. These changes may include:
- Depression
- Apathy, or a lack of interest in normal daily activities or events and less social interaction
- Anxiety and related behaviors, such as asking the same questions over and over or being angry or fearful when a loved one is not present
- Agitation, or restlessness, and related behaviors, such as pacing, hand wringing, an inability to get settled, constant repeating of words or phrases, or irritability
- Delusions, or strongly held false beliefs or opinions not based on evidence. For example, a person may think his or her spouse is having an affair or that relatives long dead are still living.
- Paranoia, or an extreme, irrational distrust of others, such as suspicion that people are taking or hiding things
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Lack Of Vitamin B12 And Lack Of Thiamine
Vitamin B12 is found in meat, fish, eggs and cheese. Thiamine is also a B vitamin and is found in whole-grain foods, some breakfast cereals, beans and peas, nuts and seeds.
Both are important for a healthy nervous system. If someone doesnt get enough of either of these vitamins, they can have symptoms that could be mistaken for dementia. These include confusion, memory loss, irritability and a change in mental state.
Coping With Cognitive Changes
Some medications used to treat Alzheimer’s disease also may be used to treat the cognitive symptoms of LBD. These drugs, called cholinesterase inhibitors, act on a chemical in the brain that is important for memory and thinking. They may also improve hallucinations, apathy, and delusions. The U.S. Food and Drug Administration has approved one Alzheimer’s drug, rivastigmine, to treat cognitive symptoms in Parkinson’s disease dementia. Several other drugs are being tested as possible treatments for LBD symptoms or to disrupt the underlying disease process.
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I Will Develop Alzheimers Disease If My Parent Has It
If a parent or close relative has Alzheimers disease, you may be worried about developing it as you get older. A persons chance of developing Alzheimers is higher if they have certain genetic mutations or variations that can be passed down from a parent. However, just because a biological parent has Alzheimers does not mean that their children will develop it.
Alzheimers disease is complex, and scientists dont yet fully understand what causes it in most people. Research suggests that in most individuals, a host of factors beyond genetics play a role in the development and course of the disease. Environmental and lifestyle factors, such as exercise, diet, exposure to pollutants, and smoking may also affect a persons risk for Alzheimers. Although we dont yet know how to prevent Alzheimers, its important to practice healthy behaviors throughout your lifetime, such as exercising regularly and eating a balanced diet.
Learn more about Alzheimers disease genetics.
What Is Dementia And What Are The Symptoms
Dementia is the term for a group of symptoms that occur when the brain is damaged by diseases. This includes Alzheimer’s disease or diseases of the blood vessels that can cause a stroke. These diseases can cause a significant decline in a person’s mental abilities or ‘cognitive function’ – our capacity for things like memory, thinking and reasoning.
For a doctor to diagnose dementia, a person’s symptoms must have become bad enough to significantly affect their daily life, not just be an occasional minor irritation. This means having new problems with everyday activities about the house, in the community or at work. For example, starting to have problems paying household bills, using the phone, managing medicines, driving safely or meeting up with friends.
If a person has symptoms that are worse than would normally be expected for a healthy person their age, but are not severe enough to significantly affect their daily life, a doctor may diagnose mild cognitive impairment . This is not a type of dementia, though some people who have MCI will go on to develop dementia.
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What Is Down Syndrome
Down syndrome is a genetic disorder caused when, due to a biological error at the time of conception, a person has 3 copies of chromosome 21 in every cell body instead of the usual pair, so upsetting the gene balance. This extra gene material causes a collection of characteristics which can result in some degree of developmental delay and some common physical traits.
Treating Movement Symptoms In Lewy Body Dementia
LBD-related movement symptoms may be treated with medications used for Parkinson’s disease, called carbidopa-levodopa. These drugs can help make it easier to walk, get out of bed, and move around. However, they cannot stop or reverse the disease itself. Side effects of this medication can include hallucinations and other psychiatric or behavioral problems. Because of this risk, physicians may recommend not treating mild movement symptoms with medication. Other Parkinson’s medications are less commonly used in people with LBD due to a higher frequency of side effects.
People with LBD may benefit from physical therapy and exercise. Talk with your doctor about what physical activities are best.
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Lung And Heart Disorders
Disorders of the heart and lungs are some of the top answers available for anyone who asks what conditions can be mistaken for dementia.
This is mainly because the two organs provide nutrients and oxygen to the brain hence, they are essential for normal functioning.
As people age, they may develop vascular diseases that interrupt cardiac output. Others can get lung diseases that affect oxygen delivery to the brain.
When this happens the affected person may have issues with executive function, memory, and alertness which can fool people into thinking that it is dementia.
Problems With Vision And Hearing
Sensory limitations, too, can create a picture like cognitive impairment that worsens as the affected person becomes increasingly isolated as a result of hearing or vision problems. Recent research has emphasized that there is a relationship between hearing loss and the risk for development of cognitive impairment.
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Treatment And Care For Lewy Body Dementia
While LBD currently cannot be prevented or cured, some symptoms may respond to treatment for a period of time. An LBD treatment plan may involve medications, physical and other types of therapy, and counseling. A plan to make any home safety updates and identify any equipment can make everyday tasks easier.
A skilled care team often can suggest ways to improve quality of life for both people with LBD and their caregivers.
There Are No Treatments Available For People With Alzheimers Disease
There has been significant progress toward developing better treatments for people with Alzheimers. Several medications are available that can help treat people with Alzheimers disease. There are also coping strategies to help manage behavioral symptoms.
While there is currently no cure for Alzheimers disease, thanks to scientific advances, research has never been more promising. In total, NIA is funding more than 250 clinical trials including both drug and nondrug interventions. These include testing treatments that target behavior and lifestyle factors as well as underlying causes of the disease.
Learn more about how Alzheimers disease is treated and where to find Alzheimers clinical trials.
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Health Conditions With Dementia
By Ben Isaac 9 am on May 27, 2021
Dementia is a medical condition characterized by a loss of memory and cognitive skills. However, seniors dont necessarily have dementia just because they misplace their car keys or forget the names of old acquaintances. Dementia is a complex disorder that can share some similarities with other medical issues. The symptoms of these five health conditions are frequently mistaken for dementia.
Symptoms Or Conditions Mistaken For Dementia
Expert reviewers, Dr Pravir Sharma, Consultant in Mental Health Care and Old Age Psychiatry and Dr Adrian Raby, General PractitionerNext review due December 2024
Dementia can sometimes be difficult to spot because it develops slowly, especially in the early stages. Its also easy for people to mistake dementia signs for another problem or health condition and to mistake the signs of a different problem for dementia.
This page gives an overview of problems that may cause similar symptoms to dementia.
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Dementia Doesn’t Always Mean Alzheimer’s
Dementia is any memory loss or thinking problem caused by changes in your brain. Alzheimer’s is just one type. Your memory also can be harmed by many other health issues, such as a stroke, Parkinson’s disease, or a buildup of fluid on your brain.
If you notice symptoms that have you concerned, see a doctor right away. They’ll give you a thorough exam that may include taking a sample of your blood for testing, brain imaging, and neurological testing to figure out what’s going on with your health and get you help.
Distinguishing Between Types Of Dementia
For physicians and families intent on pinning down a diagnosis, one major complicating factor is the existence of so many kinds of dementia. More than 50 conditions can mimic or cause dementia.
Alzheimers disease is by far the most common intractable condition. But other causes of irreversible dementia include blood vessel diseasevascular dementia), other degenerative disorders , slow-growing brain tumors, or infections of the central nervous system .
In some types of dementia, treatment will improve mental functioning, and in a small percentage, the dementia is completely reversible if treatment begins before permanent brain damage occurs. Thats why it is important to report to a doctor any signs of dementia as early as possible.
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Its Not Always Dementia: Top 5 Misdiagnoses
If youve been forgetting appointments or struggling to remember words or details, you might be concerned that these are symptoms of long term memory loss, such as dementia or Alzheimers disease.
Although the Alzheimers Association estimates that the number of Americans living with the disease could rise from 5 million to 16 million by 2050, researchers who studied nearly 1,000 people listed in the National Alzheimer’s Coordinating Center database found that 1 in 5 Alzheimers cases may be misdiagnosed.
Its a complex disease and a complex diagnostic process, and there is limited availability of experts, says Marc Agronin, a geriatric psychiatrist at Miami Jewish Health Systems and the author of the book The End of Old Age: Living a Longer, More Purposeful Life .
Often, people who experience subtle short-term memory changes and are easily confused dont have Alzheimers disease. Many treatable conditions have symptoms similar to Alzheimers disease or another form of dementia, and without the right diagnostic tools or training, some doctors have a hard time telling them apart.
Here are the top fiveoften treatableconditions that are sometimes mistaken for Alzheimers.
1. Other Neurocognitive Disorders
I had one patient who was rapidly deteriorating, Agronin says. His doctor said it was Alzheimers disease but didnt even do a brain scan. Turns out, the patient had a large benign tumor. He had it removed and lived another 10 years.
Its Not Necessarily Alzheimers
More than 50 conditions can cause or mimic the symptoms of dementia, and a small percentage of dementias are reversible. Two common examples are dementia caused by vitamin B12 deficiency or an underactive thyroid . Getting the right diagnosis is important so that you know what options you have, because symptoms subside when the underlying problem is treated.
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The Link Between Down Syndrome And Alzheimers Disease
Studies show that by the age of 40, almost 100% of people with Down syndrome who die have the changes in the brain associated with Alzheimers disease. Amyloid precursor protein , which is the abnormal breakdown that yields the toxic amyloid protein that forms plaques in the brain and probably damages brain cells and their connections, is coded for chromosome 21. Because people with Down syndrome have an extra copy of chromosome 21, they make 1.5 times as much APP as other people, and this seems to result in an excess tendency for the abnormal amyloid breakdown product to build up. This appears to cause earlier appearance of the brain changes typical of Alzheimers disease. However, a significant number of people with Down syndrome are older than 40 and show no signs of having Alzheimers disease. It is not currently understood why changes to the brain that are typical of Alzheimers disease do not necessarily produce the condition in people with Down syndrome.