Mistaken for Alzheimer's, NPH, is an Often Misdiagnosed Brain Condition

Elderly Latinos may suffer from a little-known but treatable brain condition that is often misdiagnosed as Parkinson’s or Alzheimer’s disease.

Normal pressure hydrocephalus or NPH is a condition where cerebral spinal fluid builds up in the brain’s ventricles, resulting in the afflicted person experiencing difficulty walking, dementia and loss of bladder control.

Because those symptoms have similarities with more common diseases that are prevalent in old age, doctors often incorrectly diagnose NPH patients, said Phillip G. St. Louis, a neurosurgeon in Orlando, Fla.

“Most clinicians are not aware of this disorder,” said St. Louis, who is the director of the Normal Pressure Hydrocephalus Program at Florida Hospital. “So when one of their patients develops a shuffling gait or forgetfulness, they are likely to ascribe those problems to old age or alternatively Parkinson’s or Alzheimer’s.”

St. Louis estimates that about 5 percent of patients diagnosed with dementia in the United States, or about 375,000 people, actually have NPH.

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He said elderly Latinos have additional roadblocks that may make getting an NPH diagnosis even harder such as language barriers, lower education levels and access to quality health care services.

“In the Latino community when a loved one develops these problems, their family members are less likely to see this as something they can challenge and possibly get help for and more likely to see it as just part of what it means to get old,” St. Louis said.

That was the case for Nildo and Alicia Harper, Cuban immigrants who led an active life as a missionaries in the Dominican Republic, Puerto Rico and Mexico, before retiring to Orlando.

Seven years ago, Alicia Harper, then 69, developed incontinence and had difficulty moving her feet when she tried to walk. “It was like her feet were stuck to the floor,” recalled Nildo Harper, who had to buy a walker for his wife and later a wheelchair.

Most distressing, though, was Alicia’s forgetfulness and confusion.

“Even in my own house, I felt that I was a new place, a strange place,” she said. “We’ve been living here for 25 years, but I didn’t recognize it.”

For several years, Nildo Harper attributed the changes to part of the aging process. “I thought it was just part of getting old,” he said. “I didn’t understand what was happening.”

Alicia Harper’s health problems worsened. She stopped going to church and could no longer play the piano, two of her favorite activities. Her husband had to care for her round the clock, bathing her, dressing her, waking her in the middle of the night to remind her to use the bathroom.

Then three years ago, Alicia Harper’s endocrinologist, who she sees for her Type II diabetes, noticed that she had become detached and suggested to Nildo Harper that he take his wife to a neurologist. The neurologist prescribed Aricept, a drug that helps people with mild to moderate dementia improve their cognitive abilities.

When Alicia failed to improve, the neurologist sent her to St. Louis, who performed a series of tests to determine the probability of her having NPH. Several weeks later, convinced that Alicia Harper had the condition, St. Louis performed surgery to implant a programmable shunt into Harper’s brain that would drain the fluid.

Within a week, Harper was showing signs of improvement and today she is nearly back to her old self.

“It’s a miracle,” her husband said. “She can play the piano and she can walk. We go to the mall and go shopping and out to eat. She can walk from the parking lot to the food court. She hasn’t used the walker in about a year and a half.”

St. Louis hopes stories like Alicia Harper’s will help the public and physicians become more aware of the condition so that more NPH patients can be diagnosed accurately.

“These patients are being robbed of their normal life and it’s not necessary,” he said. “Greater public awareness of NPH is so important.”

Nancy Averett is a freelancer for Fox News Latino.

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