Receiving news that you or a loved one is diagnosed with Alzheimer’s disease (AD) can be devastating. Some forms of dementia, like normal pressure hydrocephalus (NPH), can mimic AD, causing the patient to be misdiagnosed and live without treatment. AD does not yet have a cure, but NPH does. Understanding the differences between the two can save a life and get a loved one the treatment they need.
There’s nothing more gratifying than seeing families who thought the diagnosis was Alzheimer’s then discover there is a cure.
Warren Boling, MD, Chair of Neurosurgery
Ventricles in the brain contain fluid called cerebrospinal fluid. It cushions the brain and spinal cord, but a build-up of fluid causes NPH. The cause of the fluid build-up is not always known but can result from injury, infection, or a brain tumor.
The Hydrocephalus Association estimates that 700,000 adults have NPH, but some receive misdiagnoses with AD or Parkinson’s disease. Similar symptoms may cause many of these misdiagnoses, but the differences lie in the presentation timeline outlined by Loma University Health’s chair of neurosurgery, Warren Boling, MD.
The three symptoms shared between the two diseases are: incontinence, difficulty walking, and cognitive decline.
Timeline of NPH:
First… Incontinence and magnetic gait
Then… Cognitive decline
Timeline of AD:
First… Cognitive decline
Then… Incontinence and unsteady gait
Both AD and NPH patients will have some difficulty walking. Physicians will describe it as either an unsteady or magnetic gait. Imbalance, abnormal, and uncoordinated movements characterize an unsteady gait. Typically, the individual can stand, is very unsteady, and takes small irregular steps. A magnetic gait is an abnormality marked by an inability to lift the feet off the floor. It results in decreased mobility and an increase in falls. Individuals with NPH exclusively experience a magnetic gait.
Luckily, one surgery can treat NPH. Surgeons place a shunt in the brain to drain the excess fluid. The shunt is inserted into a ventricle in the brain. It is passed under the skin from the head, through the neck and chest, and into the abdomen. A magnet on top of the scalp allows trained personnel to adjust drainage pressure as needed to ensure the longevity of the procedure. Studies show treatment by shunt surgery is effective and substantial clinical improvement in up to 80% of the patients.
“Not only does this surgery give patients more time to live, but, more importantly, provides a dramatic increase in their quality of life,” Boling says. “There’s nothing more gratifying than seeing families who thought the diagnosis was Alzheimer’s then discover there is a cure.”