Alzheimer symptoms may stem from treatable condition

For many of those with aging family or friends, the problems sound terribly familiar. Difficulty walking. Shortterm memory loss. Confusion. Difficulty dealing with simple tasks. A lack of interest in daily activities.

Even to a doctor, these symptoms look a lot like Alzheimer’s Disease. But for an estimated 750,000 Americans, they also are the symptoms of a lesser known, frequently undiagnosed condition which most people have never heard of: Normal Pressure Hydrocephalus (NPH).

The good news is that unlike Alzheimer’s, the symptoms of NPH can be partially or even fully reversed through a surgical procedure now being performed by board certified neurosurgeon Dr. Ceslovas Vaicys at Indian River Medical Center.

“We have performed this surgery on maybe 10 patients in the past year, and every patient is doing well,” Vaicys said in an interview. “Yesterday, a patient came back to see me who had been completely disoriented, falling and unstable before surgery, and he came here on his own yesterday and is now very happy.”

But the sad news is that the number of patients who diagnosed with NPH, and who have this surgical procedure that Vaicys says can “sometimes produce close to 100 percent improvement,” is believed to be a small fraction of the total number who could be helped.

Why? The National Institute of Neurological Disorders and Stroke, which is part of the National Institutes of Health, says that because the symptoms of NPH “are similar to those of other disorders such as Alzheimer's disease, Parkinson's disease, and Creutzfeldt- Jakob disease, the disorder is often misdiagnosed. Many cases go unrecognized.”

While one would hope that primary care physicians who see elderly patients suffering from dementia would order diagnostic work, such as CT scans and MRIs, to confirm or rule out NPH, in many cases this does not occur.

But given that NPH is believed the cause of the symptoms in approximately one person in 20 afflicted with dementia, family members of seniors who observe the classic symptoms of NPH in a loved one may want to play a proactive role in seeking testing for the condition.

“If you see your father or mother become senile, having trouble walking, becoming very forgetful, possibly having to wear diapers, you may want to ask their primary care doctor if this is a possibility to consider,” Vaicys said.

“It’s important to catch this as early as possible. The earlier you catch NPH, the better,” Vaicys said. “With the procedure, your father or mother may improve significantly.”

What NPH Is: Normal pressure hydrocephalus is an excessive buildup of a water-like fluid in the brain. The fluid, called cerebrospinal fluid (CSF), is made in spaces of the brain called ventricles and circulates around the brain and spinal cord.

Each day, the body makes about 8 ounces of the fluid, and the same amount is reabsorbed into the bloodstream. When absorption of CSF is blocked, the CSF begins to accumulate in the ventricles of the brain, causing the ven- tricles to become enlarged and increasing pressure inside the head. As the ventricles expand, they can compress and damage nearby tissue.

What Causes NPH: Many cases of NPH in seniors have no known cause. At present, there is no known way to prevent NPH. However, getting early treatment when symptoms appear can increase the chance for a full or partial recovery.

Symptoms of NPH: There are three classic symptoms for normal pressure hydrocephalus.

• Abnormal walk, which is often the first symptom of NPH to appear and almost always the most pronounced. Typically, a person with NPH has trouble picking up their feet, resulting in a wide-based, slow, shuffling walk and problems going up steps and curbs. It can lead to frequent falling.
• Mild dementia, which includes short-term memory loss and difficulty dealing with simple routine tasks.
• Urinary incontinence, which is often the last apparent symptom; someone with NPH may experience frequent urgency or a complete loss of bladder control.

It’s important to keep in mind that only one or two of these symptoms may be present in someone who has NPH.

How NPH Is Diagnosed: The first step to diagnosing NPH is a magnetic resonance imaging (MRI) scan or a computerized tomography (CT) scan, along with a thorough clinical history (usually from a primary care physician) and neurological assessment (from a neurologist).

How NPH Is Treated: A neurosurgeon like Dr. Vaicys implants a programmable shunt valve to drain excess CSF away from the brain and spinal cord. The CSF is carried via a long thin tube to the abdomen, where it can be more easily reabsorbed.

The surgery is a half-hour procedure, and the patient typically spends the night in Indian River Medical Center and is sent home the following day. The pressure on the programmable shunt can be increased or decreased without additional surgery.

What Is the Outlook for a Person with NPH? With treatment, the symptoms of NPH can be partially or even fully reversed. Without treatment, the symptoms can continue to worsen and eventually lead to death.

When should I call my doctor? If you or a loved one have the classic three symptoms, call your family doctor about getting a CT scan and evaluation to test for NPH.

The American Academy of Family Physicians, in its practice guidelines, says the time to refer patients to a neurologist or neurosurgeon for a “more involved and specific work-up and confirmation or contradiction of suspicion is when even a slight chance of the diagnosis arises, or when just a loose grouping of the triad (the three symptoms) is encountered.”

About Dr. Vaicys: Ceslovas Vaicys, MD, PhD, was recruited to Vero Beach in March 2007 by the leadership of Indian River Medical Center after spending seven years at hospitals in Fort Myers and Hollywood, FL.

A native of Lithuania, he has more than 20 years experience in neurosurgery and was part of the team that performed a pioneering successful separation of Siamese twin girls in Moscow 19 years ago. He is a fellow of the American College of Surgeons and is a diplomate of the American Board of Neurological Surgeon.