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What Is Normal Pressure Hydrocephalus Dementia

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Normal pressure hydrocephalus

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Can Hydrocephalus Cause Dementia

Now, its important to note that dementia is not a specific disease. Its 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 persons ability to perform everyday activities. Because symptoms of NPH can fall under that umbrella, the disorder is often misdiagnosed as dementia. In fact, many cases of NPH go unrecognized and are never properly treated.

The difference between dementia and NPH is that hydrocephalus is treatable. A tube, called a shunt, is placed in the brain to relieve the excess fluid.

In some cases, however, surgical treatment does not resolve memory and thinking issues, or the excess of fluid may damage brain tissue. Thus, the Alzheimers Society still lists NPH as a cause of a rarer type of dementia.

Cognitive Impairments In Persons With Normal Pressure Hydrocephalus

The classic cognitive impairment is frontosubcortical dementia, which refers to a pattern of cognitive decline characterized by deficits in executive function , psychomotor slowing, and behavior and mood swings with marked apathy.5-8

Other studies have focused on differentiating cognitive dysfunction in persons with NPH from cognitive dysfunction in persons with other neurodegenerative disorders characterized by gait impairment . These studies show that antiparkinson medicines are not efficacious for treating people with NPH. In contrast to those with PD, a DaTscan imaging study with ioflupane , which binds to dopamine transporters often has normal findings in persons with NPH. In persons with AD, early stages of frontal lobe abnormalities are infrequent, but all types of memory impairment usually occur; in contrast, recognition memory is often preserved in those with NPH.

The presence of other neurologic disorders in persons with NPH is not uncommon and in 2 studies in which cortical biopsies of patients with NPH have been obtained, neuritic plaques suggesting AD or FTD were found in 34% and 41% of patients respectively.14,15 In the smaller of these 2 studies, positive biopsy was correlated with increased cognitive impairments.15

Pathogenesis of Cognitive Impairments in Persons With Normal Pressure Hydrocephalus

More studies with larger sample sizes are needed to fully understand the pathophysiology of cognitive impairments that result from NPH.

Read Also: Difference Between Senility And Dementia

Bright Outlook For Patients With Nph

Once the diagnosis of normal pressure hydrocephalus has been confirmed, with other dementias ruled out by a neurologist or neurosurgeon, a shunt, a device that shunts the CSF fluid from the brain to another part of the body, will likely be recommended if the senior is a candidate for surgery. It is important to share with seniors and caregivers that the surgical treatment for this disorder is advanced, so they should stay optimistic about improvement.

It is also worth noting to caregivers that for some patients, both NPH and another form of dementia may be present, each requiring their own differential diagnosis and treatment. In fact,;Alzheimers disease with comorbidity in NPH;is not uncommon. However, Alzheimers is not surgically treatable like NPH. Alzheimers and other forms of dementia cannot be cured, but current drug treatments can mask symptoms and help seniors better function while in mild to moderate stages.

Research has found that staying cognitively active may reduce the risk of Alzheimers;;one study;found that seniors who reported the most frequent participation in intellectually stimulating activities were 47 percent less likely to develop Alzheimers than those who had the least frequent participation.;

Current Approach To Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalus. Pathophysiology

For a more detailed approach, the reader is referred to an article by Williams and Relkin1 that covers international and Japanese guidelines.

Presentation and Clinical Evaluation

The onset of NPH is insidious, taking place over a period of at least 6 months. Persons with NPH develop a gait disorder with disturbed postural and locomotor features without sensorimotor deficits. Gait initiation failure, shuffling, festination, tripping, and falling are often present; whereas, spasticity, hyperreflexia, and other upper motor neuron signs are not typical. Lateralizing findings are also not typical. Persons with NPH commonly have urinary urgency with difficulty emptying the bladder. Cognitive impairment is usually dementia, which includes apathy, amotivation, psychomotor slowing and features of executive impairment with or without visuospatial abnormalities, impaired receptive or expressive language, or impaired naming not benefited by cueing and hallucinations. Importantly, these cognitive changes often overlap with other neurologic causes of dementia and are not unique to NPH.

Differential Diagnosis

Diagnostic Criteria

Infusion testing for assessment of CSF in suspected NPH is done more commonly in Europe. The test infuses artificial CSF via 1 spinal needle while simultaneously recording from a second spinal needle.4 Infusion testing requires specialized equipment and considerable expertise to perform.


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How Common Is Normal Pressure Hydrocephalus

It is difficult to know how many people actually have normal pressure hydrocephalus because its symptoms are similar to other diseases, such as Alzheimer’s or Parkinson’s disease, or even the natural aging process itself. However, it is estimated that as many as 10 percent of people with dementia attributed to other disorders may actually have NPH.

How Is Normal Pressure Hydrocephalus Treated

Although there is no cure for NPH, the symptoms can be managed through surgery. Surgery involves inserting a drainage system called a shunt. One end of the shunt — which is a long sturdy, flexible plastic tube — is placed into one of the brain’s ventricles. The other end is tunneled under the skin to another area of the body, usually the lower part of the abdomen.

The shunt allows the excess cerebrospinal fluid to drain from the brain and be absorbed back into the body. A valve in the shunt keep the fluid flowing in the correct direction and at the right rate. The shunt remains in the person’s body for the rest of his or her life.

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Who Gets This Disorder

The number of people who develop hydrocephalus or who are currently living with it is difficult to establish since;the condition occurs in children and adults, and can develop later in life.;A 2008 data review by the University of Utah found that, in 2003, hydrocephalus accounted for 0.6 percent of all pediatric hospital admissions in the United States. Some estimates report one to two of every 1,000 babies are born with hydrocephalus.

What Are The Symptoms

Ask the Expert – NPH Episode 1: Dementia or NPH?

The symptoms of hydrocephalus can vary significantly from person to person and mostly depend on age. ;Conditions other than hydrocephalus can cause similar symptoms so it is important to see a doctor to receive proper diagnosis and treatment.InfantsSigns and symptoms of hydrocephalus in infants include:

  • a rapid increase in head size
  • an unusually large head

Brain imaging and other testsTests to accurately diagnose hydrocephalus and rule out other conditions may include:

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What Treatments Are Available

There is no cure for NPH, and there is no medication available. However, a CSF shunt can provide symptom relief to some patients. Implanted surgically, the device removes excess fluid from the ventricles. If the lumbar drain trial is successful, the patient may be a good candidate for a permanent CSF shunt. Because NPH is usually a progressive disorder, the shunt extends quality of life for the patient but symptoms of NPH may return.

Sometimes a patient with NPH may be unable to have a shunt because of other health problems that would make surgery unsafe. Treatment of that condition may improve the patient’s health enough so that he or she can undergo shunt surgery safely.

Can A Person With Hydrocephalus Drive

Hydrocephalus typically affects visual acuity, coordination, judgment, and concentration, all of the skills which are necessary to drive. Just learning how to coordinate between controlling the steering wheel and applying the accelerator or brake can be a daunting task when you have poor motor skills.

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Overview Of Normal Pressure Hydrocephalus

Normal pressure hydrocephalus is characterized by hydrocephalus with normal intracranial pressure, gait disorder, incontinence, and cognitive impairment. The pathophysiology of normal pressure hydrocephalus is poorly understood and is believed to have something to do with decreased absorption of cerebrospinal fluid rather than over-production. If there is obstruction of cerebrospinal fluid, by definition normal pressure hydrocephalus is not present. Definitive treatment is placement of a ventriculoperitoneal shunt to drain excess cerebrospinal fluid out of the central nervous system . As reviewed in detail by , the likelihood of normal pressure hydrocephalus being present can be stratified as probable, possible, and unlikely, depending on history, physical findings, and supporting studies .

Normal pressure hydrocephalus is felt to be unlikely if ventriculomegaly is not present, if there is an absence of any component of the normal pressure hydrocephalus triad , if there is elevated intracranial pressure and finally if symptoms can be accounted for by another neurological disorder .

What Is The Outlook For People With Normal Pressure Hydrocephalus

A Comparison of Normal Pressure Hydrocephalus to Alzheimer ...

The chance of a good recovery from NPH is more likely if a patient is diagnosed and treated in the early stages. Some people do not need shunt surgery because the symptoms are not severe enough to affect daily life. People who do not need surgery should continue to have check-ups with a doctor to monitor the symptoms. If the symptoms worsen, the doctor may recommend the surgery. Those who get surgery, often find that their symptoms are manageable.

Last reviewed by a Cleveland Clinic medical professional on 08/27/2018.


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Support Groups And Counseling For Normal Pressure Hydrocephalus

Coping with the symptoms of NPH can be difficult for both you and your family members. The condition affects every aspect of your life, including family relationships, work, financial status, social life, and physical and mental health. You may feel overwhelmed, depressed, frustrated, angry, or resentful. These feelings do not help the situation and usually make it worse.

This is why support groups were invented. Support groups are groups of people who have lived through the same difficult experiences and want to help themselves and others by sharing coping strategies.

Support groups meet in person, on the telephone, or on the Internet. To find a support group that works for you, contact the organizations listed below. You can also ask your health care provider or behavior therapist, or go on the Internet. If you do not have access to the Internet, go to the public library.

For more information about support groups, contact the following agencies:

  • Family Caregiver Alliance, National Center on Caregiving – 445-8106
  • Hydrocephalus Association – 732-7040 or 598-3789
  • Hydrocephalus Foundation, Inc. – 942-1161
  • Hydrocephalus Support Group, Inc. – 532-8228
  • What Is Normal Pressure Hydrocephalus

    This information comes from Alzheimers Society, a wonderful organization based out of the UK. They are one of my go-to sources for information and I highly recommend taking a look around their website. They offer the information on their website to be freely used by others, so I am posting the information in full. You can access the same article on their website as well as resources on dementia by clicking on the title, below.

    Normal pressure hydrocephalus is one of the rarer forms of dementia and one of the treatable forms.

    Recommended Reading: Difference Between Dementia And Senility

    How To Prevention Nph

    There is no known way to prevent NPH. A healthy lifestyle, including not smoking, maintaining a healthy weight, and regular exercise, may help avoid conditions such as high blood pressure, heart disease, diabetes, and stroke that might contribute to NPH. Wearing a seatbelt and safety helmet when indicated can help avoid head injury, another cause of NPH.

    Causes Of Potentially Reversible Dementia Symptoms

    Normal Pressure Hydrocephalus: NPH From Diagnosis To Treatment

    Worried that a loved one has;Alzheimer’s disease? While you may be right, you should be sure to have a physician;conduct a thorough evaluation;to be certain. Some illnesses and conditions that look and act like Alzheimer’s are reversible with appropriate treatment.

    Here are 10 potentially reversible causes of;dementia symptoms:

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    A Triad Of Symptoms Mri And Lumbar Puncture To Diagnose Nph

    Normal pressure hydrocephalus is an enlargement of the spaces in the brain, called ventricles, that contain cerebrospinal fluid a clear fluid that bathes the brain and spinal cord and is often termed abbreviated CSF.

    Normal pressure hydrocephalus causes difficulty walking, thinking, and controlling the bladder. Symptoms can improve when a neurosurgeon places a drain called a shunt into the ventricles;so that CSF flows into the abdomen instead of flowing down the spinal column. Any neurosurgical procedure carries some risk, however, and the benefits of placing such a stent for NPH are not always certain so it’s critical NPH be properly diagnosed. Even after this step, some patients may improve more with stent placement than others.

    Support For Normal Pressure Hydrocephalus

    Coping with the symptoms of NPH can be difficult for both you and your family members. The condition affects every aspect of your life, including family relationships, work, financial status, social life, and physical and mental health. You may feel overwhelmed, depressed, frustrated, angry, or resentful. These feelings do not help the situation and usually make it worse.

    This is why support groups were invented. Support groups are groups of people who are going through the same things and want to help themselves and others by sharing coping strategies.

    Support groups meet in person, on the telephone, or on the internet. To find a support group that works for you, contact the organizations listed below. You can also ask your health care provider or behavior therapist, or go on the internet. If you do not have access to the internet, go to the public library.

    For more information about support groups, contact the following agencies:

    • Family Caregiver Alliance, National Center on Caregiving — 445-8106
    • Hydrocephalus Association — 732-7040 or 598-3789
    • National Hydrocephalus Foundation — 924-6666
    • Hydrocephalus Support Group, Inc. — 532-8228

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    Nph Misdiagnosed As Dementia

    As we know at ANA, doctors may use a variety of tests, including brain scans , 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 in 2014 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.

    How Is Normal Pressure Hydrocephalus Diagnosed

    nph, normal pressure hydrocephalus, hydrocephalus, vp ...

    Diagnosis begins with a careful review of symptoms and medical history. medical interview and a physical exam. Other tests include:

    • Imaging tests. A CT scan or MRI of the head is done to look for enlarged ventricles in the brain.
    • Cerebrospinal fluid tests. These tests include a spinal tap and external lumbar drainage. During a spinal tap, a small sample of cerebrospinal fluid is removed and the patient is assessed to see if the symptoms improve. During external lumbar drainage, cerebrospinal fluid is removed through a special catheter over a 36-hour period to further see if symptoms improve dramatically and to test the potential benefit of implanting a shunt .
    • Gait analysis . This is a timed walk test. The patient is watched as he or she walks 10 meters .
    • Neuropsychological testing. This involves a series of assessments to determine if there is a loss of brain function due to NPH.

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    Normal Pressure Hydrocephalus Treatment And Home Care

    Normal pressure hydrocephalus can sometimes be managed or possibly even reversed through surgery. For those who are not candidates for surgery, treatment consists of measures to relieve mood and behavioral problems, cope with physical problems such as incontinence and walking difficulties, and maximize physical, mental, and social functioning.

    Surgery for normal pressure hydrocephalus

    Normal pressure hydrocephalus is not caused by any structural abnormality, such as a brain tumor. In most cases, the underlying problem is not known or cannot be treated. The treatment in these cases is a shunt operation.

    A shunt is a thin tube that is implanted in the brain by a neurosurgeon. It is inserted into the ventricles to drain excess CSF away from the brain. The tube is routed under the skin from the head to another part of the body, usually the peritoneum . The shunt is equipped with a valve that opens to release fluid when the pressure builds up. The fluid drains harmlessly and is later absorbed by the bloodstream. The pressure setting on the valve sometimes must be readjusted. The newer shunts allow adjustment without another operation.

    A shunt operation is not a cure. It does not treat the underlying cause of NPH. It can, however, relieve the symptoms. The shunt remains in place indefinitely. If properly implanted, the shunt often is not obvious to other people.

    Caring for someone with normal pressure hydrocephalus


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