Alzheimer's Disease and other Dementias
ThirdAge Health Close-Up: NPH, the Curable Dementia
During 2004, when Alicia Harper was 69, her husband began to notice heartbreaking changes in the way his smart, vibrant wife was behaving.
“She was becoming disconnected,” Nildo, now 83, says. “She was confused and always forgetting things. And when we would visit with any of our four children and eight grandchildren, she didn’t seem to feel anything for them. I just assumed she had the beginnings of Alzheimer’s disease. I took her to several doctors and they thought so, too.”
Alicia’s cognitive decline worsened as the years passed. She also began to have trouble controlling her bladder. Nildo, a retired physics and math professor, became her round-the-clock caregiver. “I couldn’t believe that this woman who is the love of my life was slipping away from me,” he says. “She had a long career as a teacher of secretarial science and as the secretary at our church here in Orlando. Yet day by day, she was losing her intellectual abilities. She started saying, ‘Why am I in this bedroom? Where am I?’ And we had lived in the same house for 25 years.”
Because Nildo knew that Alzheimer’s is progressive and eventually fatal, he resigned himself to the fact that Alicia would never get better. Gone were the days when the whole family would gather around the piano while Alicia would play from memory the national anthems of the three countries where the Harpers had lived before settling in Florida – the Dominican Republic, Puerto Rico, and Mexico. “We had singalongs,” Nildo says. “It was a wonderful bonding experience. But it got so she would just stare at the piano as though she didn’t know what it was for any longer.”
Then in 2009, five years after Alicia first started to disappear into mental oblivion, a doctor who was treating her for diabetes began to suspect that Alicia might not have Alzheimer’s after all. She had cognitive decline, to be sure, but she also had a shuffling gait and a lack of bladder control. “That’s what we now know is the ‘triad of symptoms’ for a condition called normal pressure hydrocephalus or NPH,” Nildo says. At the suggestion of the diabetes doctor, Nildo took Alicia to an NPH specialist, Dr. Phillip St. Louis.
“In the classic clinical setting, the diagnosis of NPH is usually considered after the patient has seen anywhere from two to five physicians,” Dr. St. Louis says. “Dependent upon the time delay, the patient may present in relatively advanced stages of this disorder. In general, those patients who are bedridden and have an advanced form of dementia are less likely to respond to a treatment called cerebrospinal fluid diversion or CSF. Fortunately, Alicia was still a good candidate for the procedure.”
Dr. St. Louis, who is on the staff of the NPH program at Florida Hospital Orlando, performed a CSF trial over the course of three days with a temporary shunt and baseline testing including neuropsychological, physical therapy, and radiographic imaging.