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Treatable NPH Sometimes Mistaken for Alzheimer's or Parkinson's


Research into debilitating brain diseases such as Alzheimer's and Parkinson's is shedding light on a lesser-known and more treatable condition called NPH - or normal pressure hydrocephalus.

An Internet public service announcement about NPH features one of its victims -- Bob Fowler, a retired oil company executive and active hunter and golfer in Dallas, Texas. Mr. Fowler describes the steady erosion of his motor skills and brainpower.

"This was me a couple of years ago," he says in the recording, hunched over, shuffling and barely able to stand. "As you can see, I wasn't well . . . could hardly walk . . . could barely make it to the bathroom in time. Kept forgetting things. There was talk of Alzheimer's or Parkinson's. But what I really had was a neurological condition known as NPH."

Mr. Fowler told his story recently on NBC television's Today Show. "One of the insidious things about NPH is that it starts off slowly and then accelerates," he said. "By the end of the nine years, I was in a precipitous decline."

He was sent to one medical specialist after another, until an MRI, or magnetic resonance imaging test, revealed excess fluid around his brain. That's the meaning of the H in NPH - hydrocephalus, or water on the brain.

Dr. Mark Luciano, a neurosurgeon at the Cleveland Clinic in Ohio, told NBC that about 15 percent of older Americans thought to have dementia or Parkinson's Disease may instead have NPH symptoms that can be reversed.

"We all have water on the brain," he said. "Our brains are floating in water -- salt water, really. But with hydrocephalus, it builds up like a water balloon and squeezes the brain and stretches it."

Dr. Paul Vespa, one of the directors of an adult hydrocephalus program at the UCLA Medical Center in Los Angeles, says NPH is difficult to spot in its early stages. The problem is that -- even though the disease compresses the brain -- fluid pressure readings are normal. That is why the disease is called normal pressure hydrocephalus. Then, if early brain scans miss the telltale signs, families often accept a grim prognosis of inevitable decline:

"In the past, they would say, 'Well, Grandpa's having problems walking…that's just old age,'" says Dr. Vespa. "A lot of primary care physicians most likely would say, 'Well, this is just age, and it doesn't look so bad right now.'"

Treatment for NPH involves implanting what's called a programmable shunt. It consists of a sort of spigot and tube that divert excess fluid from the skull to the abdomen, where it is more easily absorbed. But Dr. Thomas Rosenthal, a family physician who treats geriatric patients in Buffalo, New York, sounds a cautionary note. "The shunt works in only about a third of the cases," he says. "And then, even in those cases…it may last for six months or a couple years, and then frequently people will begin to dwindle again."

So far, that has not happened to Texas oilman Bob Fowler. After treatment, "I was thinking differently," he told NBC. "I had clarity of thought that I had not experienced in years."

"One of the remarkable things about hydrocephalus is that you can accomplish nearly a full recovery, and very quickly," he said. "It wasn't long until I was back to playing golf, back to driving a car - which I hadn't done for quite some time. But importantly, my wife and my son got their lives back, because they had been in prison just as surely as I was."

But for others for whom the diagnosis is the more ravaging Alzheimer's or Parkinson's disease, no such restorative procedure has yet been developed.

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