My mother is having surgery this week. Mom worked hard after falling and breaking her leg last fall and as a result, was able to return to living semi-independently. However, something was not quite right. She complained of feeling woozy all the time and started to show noticeable signs of cognitive decline. The family, along with her doctors, initially concluded this was probably normal decline associated with aging. Few of us will reach 85 without having physical and/or cognitive problems of some sort. Right? We should expect declines as we age. We’re told it’s normal and expected. Then one day she reached a tipping point as she had increased difficulty speaking, choosing her words, and tracking the conversation.
The neurosurgeon on call in the emergency room that Sunday afternoon diagnosed her condition as NPH, a condition that primarily affects those over the age of 55. NPH is the accumulation of cerebrospinal fluid that causes the brain’s ventricles to enlarge. The primary symptoms of NPH are urinary incontinence, difficulty walking or gait disturbance, and progressive mental impairment and dementia. While the first word of NPH is normal, this is anything but a normal aging condition. As I reviewed the information all I could focus on was the fact that the NPH symptoms defined what all my life-span text books term normal aging declines. I asked colleagues who work with older adults what they knew about NPH and received only blank stares in reply. I have wondered how many older people, told either that their experience was normal or that they had dementia, actually had NPH and could have been helped by both an accurate diagnosis and appropriate treatment.
The National Institute of Neurological Disorders and Stroke website states “Because these symptoms are similar to those of other disorders such as Alzheimer's disease, Parkinson's disease, and Creutzfeldt-Jakob disease, the disorder is often misdiagnosed. Many cases go unrecognized and are never properly treated”. How many older people studied over the decades, defined as normal older adults, were actually experiencing NHP? How many of these cases were redefined as normal aging? Screening questions include feeling as if the feet are stuck to the floor, experience of balance issues, sudden falls, poor attention, sudden urge to urinate or urinary incontinence. Medical screening involves brain scans (MRI and/or CT scan), while treatment includes the placement of a shunt to drain the excess cerebrospinal fluid. The post-surgical prognosis varies with the individual, but without treatment the prognosis is sure cognitive and physical decline.
I encourage all who read this entry and have family members, friends, or clients over 55 to become familiar with NPH. I have learned from this experience never again to conclude that any declines seen in older adults are normal. Rather than passively accepting these declines as ‘normal’ I will push for appropriate screening. I will never be able to see the phrase “normal aging declines’ in the same way again. Hopefully, as more become aware of NPH and our knowledge about our fearfully and wonderfully made bodies improves, we will be able to newly define normal aging. For additional important information on NPH please see: www.ninds.nih.gov/disorders/hydrocephalus/detail_hydrocephalus.htm
Patricia Myers is a counselor, an associate professor of counselor education, and doctoral student.