Health & Fitness

“Water on the brain” could be misdiagnosed as Alzheimer’s

FOR THE MIAMI HERALD

When an 84-year-old woman starts to lose her balance, has trouble walking or forgets details from last week or last year, common thought says she’s showing early signs of Alzheimer’s disease, perhaps Parkinson’s, or is just experiencing the normal decline that comes with aging.

That’s what Ronald Pallot figured was happening to his wife Gloria. Pallot moved quickly to keep up with his wife’s rapid decline: He put walkers in their apartment in Aventura and got Gloria a wheelchair. He led her to the kitchen, to the bathroom and didn’t schedule as many social engagements. He figured her loss of personality was a sign of dementia.

“We thought, ‘This is what it is, we’re going to live the way it is,’” Pallot said. “But it kept declining.”

That is until Gloria had brain surgery three years ago. Now 87, she no longer needs Pallot to help her around their apartment, and she can carry on a conversation about current events.

Gloria falls into the category of those suffering from normal pressure hydrocephalus, a condition caused when an excess of brain and spinal cord fluid puts pressure on brain tissue. Hydrocephalus gets its name from the Greek language: “hydro” meaning water and “cephalus” meaning head, though the variety of symptoms and conditions under the umbrella term vary widely. The condition, commonly referred to as “water on the brain,” occurs in children and adults and can be congenital or acquired. Normal pressure hydrocephalus, the kind Gloria suffered, differs greatly from the condition in infants or children, which progresses in patients more rapidly and is treated differently.

For patients like Gloria, symptoms set in over a long period of time and mirror those commonly associated with old age—memory loss, trouble going from standing upright to walking and loss of bladder control. A problem occurs when families begin preparing for their loved one’s decline, said Dr. Allen Krantrowitz, chief of neurosurgery at Mount Sinai Medical Center in Miami Beach, when they could have a treatable condition.

“It’s an ageism issue,” said Kantrowitz. “If one simply accepts the idea that with age comes slow cognitive decline, and you don’t challenge and ask questions about why it’s happening, then you’ll never identify those treatable causes of early onset dementia.”

Alzheimer’s and Parkinson’s diseases aren’t treatable, but normal pressure hydrocephalus is. To rid the pressure on brain tissue, neurosurgeons can insert a small plastic shunt into the brain that drains the excess fluid into the abdomen, where it can be safely absorbed. Gloria went to Mount Sinai for the operation, and Pallot said it was just after the anesthesia wore off that he noticed his wife’s improvement.

“She became more conversational; she seemed more alert,” Pallot said.

“He put the shunt in and that was all,” Gloria remembered. “I’m 100 percent better.”

But shunt insertion isn’t done as much as it could be, said Kantrowitz. He wants to educate families and primary physicians about this option that may not be an easy decision to make, but often is the only one.

“Mostly when we think about brain surgery, we see it as a last resort. But for patients with hydrocephalus, they welcome the procedure,” Kantrowitz said. “When you’re first told there’s nothing you can do but prepare for your decline, the thought of a surgery that will actually reverse symptoms comes as a warm welcome.”

It is estimated that 375,000 older Americans have normal pressure hydrocephalus, though the number may be greater due to misdiagnosis. The Pallots said they were “skeptical” at the thought of brain surgery because there is no definite test that confirms or denies the condition.

It took nearly a year for Gloria and Ronald Pallot to weigh their options before they had “everything to gain and nothing to lose.”

One test, called a lumbar puncture, can relieve some of the built-up pressure on the brain for a few days but may not be long enough for patients to come to a conclusion that symptoms are indeed caused by normal pressure hydrocephalus.

Kantrowitz also said that risks are much less than they used to be. Developments in recent years have made inserting shunts safer for patients. Just as GPS systems allow pilots to locate runways 20,000 feet in the sky, similar technologies allow neurosurgeons to pinpoint the exact location to insert the shunt. The plastic valves are adjustable in size, and if a patient’s symptoms return, a small adjustment to the shunt’s width can quickly address the problem.

The Pallots are back to going to dinner with friends, and Gloria no longer uses her walker to get around the house. She’s back to normal life, she said.

Follow @J2theLuna on Twitter.

2015 Hydrocephalus Association Walk

When: 10 a.m. Nov. 7, Quiet Waters Park, Shelter #10, 401 S. Powerline Rd., Deerfield Beach, 33442. Check-in begins at 8:45 a.m. Participants should register in advance.

For more information, email Angelica Haymore at southFLWALK@hydroassoc.org or call 954-661-5247.

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