Q&A Topic: A Treatable Dementia

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Deborah L. Benzil, MD, FACS, FAANS

Q. What is Normal Pressure Hydrocephalus (NPH) and why does it occur?

A. While many people fear the dementia associated with Alzheimer’s, there is considerable hope for patients with dementia related to normal pressure hydrocephalus (NPH), the only form of dementia that has the capacity for real reversal. As we age, our brains get smaller and the fluid-filled sacs in our brains called ventricles enlarge to fill in the space created by our decreased brain size. In certain people, this transition goes awry and causes NPH.

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Q. What are symptoms a patient or family member might notice in a loved one who has NPH?

A. The classic presentation of NPH includes three key symptoms. 1. An inability to lift the feet off the floor while walking, typically referred to as gait disorder. 2. Dementia, or a decline in cognitive mental processes including memory, reasoning, problem solving, and speaking is also common. 3. Finally, urinary and/or bowel incontinence are also symptoms of NPH.

Q. Why is it challenging to diagnose NPH based on symptoms? 

A. In rare cases, a thorough evaluation of symptoms is all that’s needed for a neurosurgeon to diagnose NPH. However, most patients don’t present with all three key symptoms. What makes a diagnosis even more challenging is that symptoms mirror many of those associated with irreversible conditions like Alzheimer’s and Parkinson’s. The majority of patients with NPH symptoms will need a lumbar drain trial to confirm that a diagnosis of NPH.

Q. How will a lumbar drain trial confirm an NPH diagnosis? 

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A. At Northern Westchester Hospital, patients with suspected NPH undergo a lumbar drain trial under light sedation. A small tube is inserted into the spine and over one or two days, specially-trained nurses drain a precisely measured amount of fluid every two hours. During the lumbar drain trial, cerebrospinal fluid is removed in small increments. If a patient reacts positively to the lumbar drain trial, the diagnosis is likely NPH. The first and most rapidly impacted symptom is a reversal of gait disorder. The response is not permanent and symptoms return shortly after the drain is removed.

Q. Why is NPH considered a treatable dementia?

A. Once an NPH diagnosis is confirmed, a neurosurgeon will likely recommend ventriculoperitoneal (VP) shunt surgery. During the procedure, a catheter is implanted into the fluid-filled sacs in the brain to drain the excess cerebrospinal fluid out of the brain and into the abdominal cavity. Removing the excess fluid reverses NPH symptoms. The VP shunt is programmed to drain cerebrospinal fluid according to each patient’s unique condition. Over time, we simply adjust the shunt as needed during office visits.

Q: How soon do patients and families see results after surgery?

A: The fear of dementia is understandable. But for patients with NPH, there is real hope for a reversal of symptoms. VP shunt surgery is safe, effective, and straightforward, and the results can be dramatic and life changing. Families often notice a major improvement in their loved ones ability to walk and communicate immediately following the procedure.

Dr. Benzil is a Board-Certified Neurosurgeon currently serving as Vice President of the American Association of Neurological Surgeons (AANS) with faculty appointment through Columbia School of Medicine.  She completed both her undergraduate and neurosurgical residency at Brown University in Rhode Island and an additional brain tumor fellowship through the National Institutes of Health.  Dr. Benzil has been recognized for her many scientific, clinical, and organizational accomplishments in neurosurgery nationally and internationally.  Her practice with MKMG specializes in treatment of brain tumors, the entire spectrum of spinal disorders, peripheral nerve problems, and treatment with stereotactic radiosurgery. 

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Learn More About Dr. Benzil
Director, Spine Radiosurgery Program
Northern Westchester Hospital

Northern Westchester Hospital is a proud member of Northwell Health.

Read Past Topics from Dr. Benzil:
Concussions and the Young Athlete
Brain Tumor Breakthroughs
Peripheral Nerve Injuries

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