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Normal Pressure Hydrocephalus Can Go Undiagnosed in Elderly


Normal Pressure Hydrocephalus (NPH) is a condition often misdiagnosed in older people. Medical experts say it is frequently mistaken for two other diseases: Alzheimer's and Parkinson's.

Normal Pressure Hydrocephalus is often characterized by symptoms of dementia. They include memory loss, difficulty speaking, incontinence, and changes in behavior.

Symptoms present similar to other diseases

To many doctors and patients, that sounds like Alzheimer's disease.

Sometimes patients with NPH also experience an unsteady gait, shuffling as they walk, having trouble moving their feet and maintaining balance. These are also signs of Parkinson's disease.

Ed Ferguson, 74, had symptoms that could have been diagnosed as either Alzheimer's or Parkinson's.

"I couldn't move this foot. If I stood up, it would be like it was nailed to the floor or standing in some gum," he said.

He had difficulty recognizing members of his own family.

"I couldn't go to my kids, see my grandkids, my great grandkids," he recalls. "Now I can."

Ed Ferguson got his life back because his doctor, neurologist Jeff Chen, recognized his condition as Normal Pressure Hydrocephalus.

Undiagnosed patients experience symptoms getting worse over time

"Patients may just think, well, it's just old age or problems associated with old age and may not realize it's progressive and debilitating until three or four years later," Dr. Chen said.

Normal Pressure Hydrocephalus occurs most often in people over the age of 60 .

Causes and treatment

It happens when cerebrospinal fluid, meant to provide a protective cushion around the brain and spinal cord, cannot drain out through pathways in the brain. The cavities containing the extra fluid swell and put pressure on some parts of the brain.

Dr. Chen thought he could help Ed Ferguson by inserting a shunt [tube], in his brain, to drain out the excess fluid.

Ferguson says he noticed an improvement right away.

"God, I could think again," he said. "I could talk reasonably with people. I could move."

For the moment, no laboratory test can confirm the presence of NPH.

Psychological testing can help in the first stages of a diagnosis. CT scanning can provide further clues.

Medical experts say there is no known cure.

But some patients, like Ed Ferguson, can get enormous relief with surgery.

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