Johnnie Walker has made great strides since he was diagnosed with Parkinson's Disease four years ago. Two years ago he was also diagnosed with Alzheimer's Disease. Johnnie's wife was never satisfied. For four years she pushed for more information as Johnnie's condition deteriorated. Finally, her "pushiness" paid off. Johnnie's problems actually stemmed primarily from Normal Pressure Hydrocephalus, or NPH, not Alzheimer's or Parkinson's.

What first sent Johnnie to the doctor was falls. Johnnie could not sit straight in a chair without support, and he fell frequently. Incontinence rapidly set in, as well, and Johnnie became progressively more confused. But the symptoms just didn't seem right for Parkinson's disease. Johnnie's wife compared his behavior to that of the other people attending his Alzheimer's day care program, and that didn't quite fit, either.

Finally, after much heartache and four years of misery, Johnnie secured a referral from his primary doctor for a complete neurological workup. The outcome: a diagnosis of normal pressure hydrocephalus (NPH), with the possibility of early stage cognitive impairment. It is too early to tell whether Johnnie actually has early signs of Alzheimer's Disease or another dementia, but he apparently does not have any signs of Parkinson's Disease at all.

Both incontinence and difficulty walking are important indicators of possible normal pressure hydrocephalus. Neither is usually a symptom of early cognitive impairment.

While there is no real treatment for Alzheimer's Disease at this time, NPH is treatable. While NPH cannot be "cured," it can be successfully managed. Results can be dramatic, often even immediate.

What is Normal Pressure Hydrocephalus?

Normal pressure hydrocephalus (NPH) is an abnormal increase of cerebrospinal fluid in the ventricles, or cavities, of the brain that occurs when the normal flow of fluid throughout the brain and spinal cord becomes blocked.

This enlarges ventricles and puts abnormal pressure on the brain. Normal pressure hydrocephalus can occur in people of any age, but it is most common in the elderly population. Although NPH can develop after a traumatic head injury, infection or surgery, there is not always an obvious cause.

Symptoms of NPH include problems with walking and impaired bladder control. At times a person with NPH will complain of not being able to move as quickly or smoothly as in the past, or of feeling as if his or her feet are "stuck." It is this "stuckness" that often leads to an initial diagnosis of Parkinson's Disease. Progressive cognitive impairment, or frank dementia can also result from normal pressure hydrocephalus as pressure increases in the brain and spinal cord.

How is NPH Diagnosed

Diagnosis is not simple. Doctors may use a variety of tests, including brain scans (CT and/or MRI), a spinal tap or lumbar catheter, intracranial pressure monitoring, and neuropsychological tests to help them diagnose NPH and rule out other conditions.

Treating Normal Pressure Hydrocephalus

Treatment involves surgically placing a shunt in the brain to drain excess cerebral spinal fluid into the abdomen, where it can then be absorbed by the body. This allows the brain ventricles to drain and return to their normal size, reducing the damaging pressure. Regular follow-up care by a physician is important in order to identify and correct any possible problems with the shunt.

While the success of treatment with shunts varies from person to person, some people recover almost completely after treatment and have a good quality of life. Some show signs of improvement immediately, on the same day. Early diagnosis and treatment improves the chance of a good recovery.

Regular follow-up care by a physician is important in order to identify subtle changes that might indicate problems with the shunt.

Johnnie's life has improved immensely since his shunt was placed. While he did not see 100% improvement immediately, and he continues to work with a physical therapist, he says that he did see immediate results. He no longer has problems sitting or standing straight, and he has had only a couple of falls since his surgery. He attributes those to, "feeling so good I got going too fast." Johnnie's wife says his memory is still "iffy" some days, but, "way better than it was if he doesn't get stressed."

Their words of advice: "Don't let your insurance plan keep you from getting a second opinion from a neurologist, and don't be afraid to be pushy. If we hadn't pushed, Johnnie would be much worse today and we would have had no hope."

The Hydrocephalus Association and the National Hydrocephalus Foundation both offer information about Normal Pressure Hydrocephalus and support for both families and patients.