As we age, one of the concerns is the potential onset of dementia. As we have learned from previous “Brain Matters” columns there are definitely some lifestyle adjustments that can be made to help stave off cognitive decline.
A small percentage of patients with dementia may have a brain condition called normal pressure hydrocephalus (NPH). The good news here is that with the appropriate interventions, the dementia can be reversible.
Normal pressure hydrocephalus develops in older patients and is the result of cerebrospinal fluid (CSF) build up in structures called ventricles in the brain. In an unaffected brain, the fluid in the ventricles circulates and drains within the nervous system, bathing and cushioning the brain and spinal cord. In NPH, the fluid accumulates, enlarging the ventricles and causing decreased function of the brain.
The triad of symptoms associated with NPH includes a specific type of walking difficulty (shuffling steps), urinary incontinence and memory loss. If you suspect NPH, your physician can do a work up which includes an office evaluation as well as imaging studies such as an MRI or CT scan to confirm a diagnosis. If there is a suspicion of NPH, a confirmatory test is necessary – a lumbar puncture to drain cerebrospinal fluid followed by a memory and walking evaluation.
Definitive treatment is by various surgical procedures including placement of a ventriculo-peritoneal shunt draining brain fluid into the abdomen. In some cases, an endoscopic procedure may also be possible. A majority of patients experience relief and are able to return to a normal life.
Adapted from the original article published in the May 2019 issue of the Santa Monica Star.
Dr. Garni Barkhoudarian is an expert neurosurgeon and director of the Pacific Adult Hydrocephalus Center at Pacific Neuroscience Institute. His philosophy for virtually all intracranial procedures is to apply the keyhole concept of minimizing disturbance to the brain and its supporting structures.