DEAR DR. GOTT:
A relative of mine has been diagnosed with Parkinson’s disease. We have found that normal pressure hydrocephalus (NPH) has many of the same symptoms. Would you please explain the difference between the two diseases and advise the correct treatments?
DEAR READER:
First, I will briefly discuss hydrocephalus.
The body produces about eight ounces of cerebrospinal fluid (CSF) each day. Almost all of that fluid is reabsorbed into the bloodstream. When this fails to occur, as with head injury, stroke, meningitis or when a tumor develops, an imbalance occurs. This problem is known as hydrocephalus. There are two known forms, congenital and acquired. Congenital hydrocephalus generally occurs at birth. The acquired form (NPH) most frequently occurs in individuals over the age of 60.
Now, the problem. Symptoms include gait abnormalities, difficulty walking up and down stairs, confusion, urinary frequency and urgency, and short term memory loss. As you pointed out, these are also symptoms tied to Parkinson’s and also to Alzheimer’s.
Normal pressure hydrocephalus differs from congenital hydrocephalus in that pressure in the head may have fluctuations of CSF from high to low or even normal. Some cases are linked to bleeding in the brain or result from a blockage in the flow of CSF through and around the brain and spinal cord.
Diagnosis is made through computed tomography, magnetic resonance imaging, lumbar puncture, gait analysis, NPH protocol and more. The protocol involves a series of screening procedures to assist a physician with proper diagnosis. Part of that screening may be removal of CSF through a catheter over a 36 hour period.
Treatment of choice by a surgeon may be through an implantable shunt. The purpose of the shunt is to drain excess fluid away from the brain and spinal cord. Once the fluid is removed, symptoms can be partially or completely reversed.
Parkinson’s disease, on the other hand, occurs when nerve cells in a part of the brain die or become impaired. These cells produce a chemical known as dopamine in healthy individuals. The dopamine provides a coordinated function of the body’s muscles. When about 80% of the cells are damaged, symptoms of Parkinson’s appear. An individual may be depressed, handwriting may become cramped and illegible, a tremor may be present, there may be gait and postural abnormalities, the sense of smell may be diminished, there may be a loss of facial expression; memory and slow thinking can occur; sleep patterns, and urinary incontinence or constipation can be present.
Evaluation is generally completed by a neurologist who specializes in the disease. There are no x-rays or blood tests to confirm the diagnosis. It is chronic and progressive but affects each individual differently. Some patients may have a noticeable tremor; others may have extremely mild symptoms that don’t progress rapidly.
Medication is available and may be prescribed in conjunction with medications that act like dopamine. Studies are ongoing in treating this difficult disease.
Alzheimer’s disease is a disorder that results from the gradual loss of brain cells. Two brain abnormalities associated with Alzheimer’s include clumps of protein fragments that accumulate on the outside of cells and clumps of altered protein that accumulate within the cells.
Age is the greatest risk for developing Alzheimer’s. Statistics reveal that up to 10% of all people 65 and older and up to 50% of those 85 and older are affected.
Symptoms include memory loss, disorientation as to time and place, difficulty speaking or finding specific words, personality changes, misplacing items around a house, difficulty performing routine tasks, dressing inappropriately for the season, and more. An individual may forget a dentist appointment, not remember how to dial a phone, forget how a radio or television is turned on, or have a dramatic personality change. He or she may become fearful over simple issues and will likely become more dependent on family members or caregivers.
There is no single test to confirm diagnosis. A medical history, status of mental health, gait testing, laboratory testing and more may be required. If memory loss is tied to a drug interaction, vitamin deficiency, thyroid abnormalities and a host of other conditions, reversal of symptoms is possible. For example, vitamin E has been recommended for mild to moderate dementia. Testing is ongoing to determine if folic acid supplements that lower homocysteine levels can treat or prevent the disease. Long-term nursing home care may be needed as a patient’s symptoms progress.
Medical advances are ongoing and extremely promising, and support groups are available for both the patient and families.
To give you related information, I am sending you copies of my Health Reports “Alzheimer’s Disease” and “Parkinson’s Disease”. Other readers who would like copies should send a self-addressed, stamped, number 10 envelope and $2 for each report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the titles.
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