As an expert in memory loss, I have with my colleagues seen many cases of dementia where the cause is unknown and the course is inevitably and regrettably progressive. From time to time, however, our clinical evaluation will reveal a possible reversible cause of the symptoms, where treatment of the underlying issue -- a thyroid imbalance, depression or vitamin deficiency -- restores the patient's thinking and memory.
Normal Pressure Hydrocephalus (NPH) is a rare but reversible cause of memory loss. NPH is caused by abnormal levels of cerebral spinal fluid in the brain, which puts pressure on the brain and causes memory loss, gait imbalance and incontinence. While the causes of NPH are unknown, we can see an increase in risk with age, head trauma and infection. NPH is treated by a minor surgical procedure that places a shunt to help drain the excess cerebral spinal fluid. In many cases, the recovery of memory and other functioning is significant if not complete. Because of the reversibility of NPH, it is an important diagnosis we look for in any evaluation for memory loss.
In 1994, Beverly Jablons, a talented author and an intellectual and vivacious woman whom I was lucky enough to have as my mother-in-law, hit her head in a fall. While initially she seemed to escape severe injury, she soon began to have trouble with her balance. Over the following years she grew progressively worse, was confined to a wheelchair and had trouble communicating. While her evaluation was complicated by many factors, in the end, she was diagnosed with NPH and had surgery to place a shunt. Beverly made an almost complete recovery and went on to have eight very full years in which she wrote (including a piece in the New York Times about her experience), traveled, enjoyed her family and lived life very fully. Beverly passed away a little over one year ago while she was sitting at her desk working on her memoirs. Today would have been her 87th birthday.
One of the things that mattered to Beverly most in the years after her illness was raising public awareness about NPH. Just before her death, she wrote a column for my blog about her illness and recovery. In honor of her birthday, I share that with you here:
Once upon a time I was a vegetable -- and not the edible kind. It was August 1994 and I fell down a long flight of stone steps unwillingly and inadvertently. I rolled and bounced like a beach ball and finally cracked the back of my head on the last step. Such things have been known to happen.
Crowds gathered, an ambulance was called and a resident at the hospital examined me and determined that I did not suffer from concussion, no bones were broken and I could be taken home. However, it would be wise to watch me closely, he told my friends.
One didn't have to watch too closely to observe the deterioration of my mobility, cognizance, bodily functions and speech.
Over a period of eight years, seven neurologists could not make a diagnosis and seven MRIs revealed nothing. Nor could an acupuncturist, a physiatrist, nor a psychiatrist (although she said unequivocally that it was not emotional but physical).
That I wound up in a wheelchair was not as important to my lifestyle as the fact that I couldn't tell a story, or concentrate enough to read intelligently. I couldn't finish my sentences and, most frightening, I could not retrieve words I searched for. Did I mention that I'm a published writer? Well, this is what I do. That is who I am.
Just as my family was about to give up and just as I was described by an acquaintance as "totally out of it," an eighth neurologist diagnosed my case, identifying my condition as Normal Pressure Hydrocephalus and recommended surgery, shunts inserted to reroute the flow of fluid that was causing pressure on my brain. It's assumed it resulted from the blow on the head in 1994.
After years in a wheelchair, I have to admit I do use a cane -- but I don't care! My cognizance is back, my comprehension is back, my words are back, I am writing a book, my brain is functioning, I'm 85 now and alive again. Thank you for asking!
For more information about Normal Pressure Hydrocephalus, visit this page from the National Institute of Neurological Disorders and Stroke.
For more by Cynthia R. Green, Ph.D., click here.
For more on the mind, click here.
For more on brain science, click here.