The nightmare of NPH.

• Author: Marmarou, Anthony
• Position: Normal pressure hydrocephalus - Medicine & Health

IMAGINE YOUR spouse, parent, or grandparent gradually starts to shuffle while walking or becomes dizzy, incontinent, and forgets incessantly. Many believe these symptoms simply are a sign of old age-and it is time to consider a nursing home or assisted living facility. Perhaps those who sought help were told by health professionals that there was no cure or medicine for their mysteriously deteriorating health when, in fact, what they really had was a treatable condition that very likely could be reversed. For people with normal pressure hydrocephalus, or NPH, this scenario is not at all uncommon.

NPH, one of the most underrecognized and misdiagnosed conditions, affects an estimated 375,000 adults over the age of 60. Most, however, do not even know they have it because they may have been told they have Alzheimer's or Parkinson's disease, another form of dementia, or even that their condition is a result of an aging brain and nothing can be done about it. Such misdiagnosis, or no diagnosis at all, leaves many seniors suffering needlessly and dependent on others, oftentimes for years before the condition is identified correctly and they receive effective treatment.

Bill Fuller (not his real name) knows this all too well. Over a period of nine years beginning in 1990, Fuller--former chairman of a Texas oil company, husband, father of two children, and grandfather--ventured from doctor to doctor in search of a diagnosis for his steadily deteriorating mental and physical health. During this time, he went from being a physically and socially active man who ran a multimillion dollar company to someone who could not think clearly or walk without tailing. He was forced to retire, lost his independence, became incontinent, and barely was able to walk. Ultimately, his family considered moving him to a nursing home when the demands of his condition became overwhelming. He even wrote a farewell letter to his two-year-old granddaughter and his own obituary, thinking that whatever he had soon was going to kill him.

Fuller had been referred from one medical specialist to another in the hope that at least one of them could uncover what was wrong with him. At one point, he was told he had Parkinson's disease, because of his difficulty walking. Finally, after nine frustrating years, he was diagnosed correctly with NPH. Once properly treated, he experienced an almost immediate recovery. He could think clearly again and, after living with a contusing, disabling illness that robbed him of so many productive years, he was able to resume his normal, active lifestyle.

NPH is a progressive neurological condition in which excess cerebrospinal fluid (CSF) causes ventricles in the brain to enlarge. It sometimes is referred to as "water...