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Sometimes family members—or even other doctors—will ask me whether it is worth evaluating individuals with memory loss because “there is so little that can be done for them.” Although I believe that there is a lot that can be done to help people with memory loss, one answer to that question comes from a story I heard last week at our support group for caregivers. It reminds us that some causes of memory loss and dementia are quite treatable.
“Incontinence was the big problem with my father. When his walking slowed down and he had trouble paying attention and remembering things, we thought it was just part of old age. But then he started having trouble controlling his bladder. He needed to rush to get to the bathroom, but—because his walking was slow—he couldn’t make it on time, and he would end up peeing in his pants. We went first to his primary care doctor and then to the urologist. Neither could help him and the problem was getting worse. Finally, someone told us that the problem could be due to too much fluid in the head. That’s when we were referred to the neurosurgeon.”
Normal pressure hydrocephalus (often referred to by its initials, NPH) generally starts with a slowing of the walking, small steps, and a need to run to the bathroom to urinate. It is caused by an excess of fluid in the brain. Studies show that after treatment with a shunt (a tube that drains the excess fluid) the deterioration of thinking and memory is halted and there is improvement in the walking and the urgent need to urinate.
Common thinking and memory problems that occur in normal pressure hydrocephalus include poor attention, being easily distracted, difficulty performing complicated tasks, loss of interest in activities, and slowness in thought and movement. It is difficult to pay attention when new memories are being formed and retrieved.
Normal pressure hydrocephalus is an uncommon disorder and, in the end, all dementias lead to problems with thinking and memory, walking, and urinary incontinence. But because normal pressure hydrocephalus can often be successfully treated—stopping the decline in function—it is always worth considering.
Common features of normal pressure hydrocephalus
Thinking and memory problems
- Poor attention
- Being easily distracted
- Difficulty performing complicated tasks
- Loss of interest in activities
- Slow thinking
- Difficulty forming and retrieving memories
Walking difficulties
- Slow walking
- Short or little steps
- Slow, multi-step turns
- Poor balance
- Tendency to fall backwards
Urinary problems
- Urgent need to urinate
- Increased urinary frequency
- Urinary incontinence
Other treatable causes of dementia include vitamin B12 deficiency, Lyme disease, thyroid disorders, and syphilis. Even if it is just to make sure that your loved doesn’t have normal pressure hydrocephalus or any of these other disorders, it is always important for memory loss to be evaluated.
Key Question:
Q: Your loved one’s walking has become very slow and they need to rush to urinate. Should you speak with the doctor about whether they might have normal pressure hydrocephalus?
A: Yes. Normal pressure hydrocephalus is one of the most treatable causes of dementia. The outcomes are better when detected and treated early, so make an appointment for them to see the doctor today.
© Andrew E. Budson, MD, 2019, all rights reserved.
References
Budson AE, O’Connor MK. Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It, New York: Oxford University Press, 2017.
Budson AE, Solomon PR. Memory Loss, Alzheimer’s Disease, & Dementia: A Practical Guide for Clinicians, 2nd Edition, Philadelphia: Elsevier Inc., 2016.
