Elderly Must Be Careful: Normal Pressure Hydrocephalus Requires Urgent Treatment
An important and common disease in the elderly is brain-related diseases, especially dementia. When there is an abnormality in the brain, symptoms can vary. To accurately diagnose brain diseases, special tools are required to detect abnormalities and provide appropriate treatment. One brain condition often found in the elderly is Normal Pressure Hydrocephalus (NPH), which is one cause of dementia. This disease is usually found in people aged 60 and above, with similar prevalence in both men and women. Although this condition is not very common, about 1-5 cases per 100,000 population, if any of the following symptoms or abnormalities appear even slightly, one should promptly see a doctor for diagnosis.
What are the symptoms when there is fluid accumulation in the brain ventricles?
-
- Abnormal walking: Patients cannot walk normally using their legs. They have difficulty walking up or down stairs or on slopes. The walking pattern is slow, with short steps, legs spread apart due to poor balance, or staggering because of dizziness. However, patients do not have obvious weakness in both legs.
- Dementia: Relatives may notice that the patient has poor concentration, lethargy, worsening short-term memory, and forgetfulness of recent events. These symptoms gradually worsen over 6 months to 1 year.
- Urinary incontinence: Frequent urination, inability to hold urine, and not reaching the bathroom in time.
The disease progresses with abnormalities in three main areas as mentioned: starting with abnormal walking, followed by dementia, and lastly urinary incontinence. Therefore, we should observe elderly family members at home. If abnormal walking begins, they should see a doctor immediately because early treatment before symptoms worsen usually results in better outcomes and a higher chance of recovery.
Causes of this disease are divided into 2 groups:
-
- Idiopathic group: The absorption of cerebrospinal fluid (CSF) back into the veins decreases for unknown reasons, causing accumulation of fluid in the brain ventricles. The ventricles slowly enlarge, affecting brain tissue and causing the symptoms mentioned. However, the pressure inside the ventricles remains normal, hence this condition is called “Normal Pressure Hydrocephalus.”
- Secondary group: Causes include subdural hemorrhage, infections of the meninges or meningitis, severe brain trauma such as falls from heights, accidents, or head injuries from vehicle collisions.
Diagnostic approach
Doctors diagnose by considering the patient’s history and symptoms along with physical examination and brain imaging such as CT scan or MRI. These scans show enlarged ventricles without evidence of brain atrophy. Doctors may perform a lumbar puncture to drain about 30 cc of cerebrospinal fluid and then assess the patient’s symptoms, especially walking improvement. Improvement after drainage supports the diagnosis of this disease.
Treatment of this disease is divided into 2 main parts:
-
- For patients at high surgical risk, after draining fluid from the ventricles, treatment with medication to reduce CSF production is given. Patients with mild symptoms often improve.
- Surgical placement of a shunt/tube to drain fluid from the brain ventricles to the abdomen is a minimally invasive surgery with almost no blood loss and short operation time, thus low risk. Surgery is usually performed if medication is ineffective, repeated drainage is needed, or symptoms are severe at diagnosis. Most patients improve after surgery, especially in walking. However, delayed treatment can worsen the condition, leading to inability to walk, severe dementia, and eventual bedridden status.
Self-care for patients
-
-
- Patients should strictly follow doctors’ instructions regarding medication and daily activities.
- Be cautious of falls and accidents. If traveling by motorcycle, wear a helmet.
- Train regular urination habits and avoid holding urine frequently.
- Exercise the brain by thinking and playing simple brain-training games to help slow brain degeneration.
- Eat a balanced diet with all five food groups in appropriate amounts, control weight to avoid obesity, and follow dietary recommendations from doctors.
- If any abnormal symptoms occur, see a doctor immediately.
-
Therefore, if an elderly family member shows unusual symptoms such as abnormal walking, staggering, difficulty walking, or poor short-term memory, they should be taken to see a doctor promptly to evaluate whether it is Normal Pressure Hydrocephalus. This disease responds well to treatment and has a high chance of recovery if treated early, allowing patients to return to a normal and happy life.
Dr. Rudeerat Wattanawong
Neurology and Brain Center Physician
Phyathai 3 Hospital
