I have been carrying around an article I found in the
November 11, 2012 issue of Parade
Magazine, a Sunday newspaper supplement.
The title, What if Grandpa Doesn’t
Really Have Alzheimer’s? was a case study in misdiagnosis. The story described Mr. Jimmy Howell’s mental
and physical decline. His symptoms
included altered speech, altered gait and walking, and cognitive [brain]
changes including disorganization and confusion. Unfortunately, Howell lost his job due to his
declining health and he and his wife, Ann, assumed it was “old age.” However, when Howell could not remember his
wife’s name, she took action and actively sought a correct medical
diagnosis.
Initially, Howell was diagnosed with Parkinson’s Disease
and then later, Alzheimer’s Disease and the medical community could not agree
on his diagnosis. They finally went to a
neurologist, who took an MRI and compared it to a previous image from a few
years earlier. Howell had a treatable
and reversible condition, NPH, or Normal
Pressure Hydrocephalus.
NPH is a neurological condition that occurs in older
adults and is an accumulation of cerebrospinal fluid that causes the ventricles
of the brain to enlarge, stretching nerve tissue in the brain and causing
symptoms that mimic Alzheimer’s or Parkinson’s Disease. The first symptom of NPH is typically a
change in gait or difficulty in walking, dementia, and urinary
incontinence. The diagnosis of NPH is
made with a complete neurological assessment including CT and/or MRI scans and
cerebrospinal fluid flow studies. According
to Dr. Michael Williams, director of Sinai Hospital’s Adult Hydrocephalus
Center in Baltimore, the most common treatment of NPH is a surgical shunt which
diverts the excess cerebrospinal fluid to another part of the body, reducing
pressure in the brain. The procedure is
successful 85-90% of the time, resulting in a reversal of the symptoms.
The symptoms of NPH develop slowly and because it is a
condition that occurs in older adults, patients are often misdiagnosed. According to Dr. Mark Luciano, neurosurgery
director at the Cleveland Clinic, “About
30% of my NPH patients were told they had Alzheimer’s Disease or Parkinson’s…
and sometimes they were told they were just getting old.”
The Hydrocephalus Association estimates that
approximately 350,000 older adults or 5% of all people diagnosed with dementia
have NPH. Studies at the Virginia
Commonwealth University estimated that 9% of patients in assisted living
facilities may have NPH instead of dementia.
Alzheimer’s Disease is an irreversible, terminal disease
of the brain and it is estimated that 2%-5% of older adults have the
disease. This means that 95%-98% of
older adults do NOT have it. However, my
concern is that too many older adults believe that memory decline, difficulty
in walking, and incontinence are normal aging: NOT TRUE. Unfortunately, many physicians also believe
this myth and do not pursue an accurate diagnosis.
Mr. Howell had a dime-sized hole drilled into his head
and the shunt was implanted successfully.
He regained his memory and his health because he and his wife sought an
accurate diagnosis.
PLEASE seek out a second and third opinion as Howell
did. Do not assume that cognitive
decline is “normal.” If a physician tells
you that a condition is “just old age,” run… do not walk… out of the office and
find a new doctor! More later! Agedoc.
Sources on this topic:
