Dementia and Hydrocephalus: Key Questions and Insights

Q: Dementia and Hydrocephalus: Key Questions and Insights

Hello： Diagnosing dementia requires not only imaging studies but also a thorough assessment of the patient's clinical symptoms and disease progression to make an accurate diagnosis. <br>Generally, if dementia is caused by normal pressure hydrocephalus, the patient often presents

Consultation regarding dementia (suspected to be caused by hydrocephalus)?

Hello, Doctor.
I would like to ask about my father, who is 63 years old and has been diagnosed with early-onset dementia for over a year.
His main symptoms include significant short-term memory decline and some difficulties in communication and comprehension.
He is still relatively independent in daily activities, and his mood is generally normal, although he has become more lethargic and shows less interest in activities.
He has been receiving treatment at Youmin Hospital in Nantou and is taking Donepezil.
An MRI showed signs of hydrocephalus, which has led to atrophy of the hippocampus, but it is unclear whether the atrophy caused the hydrocephalus or vice versa.
The doctor advised maintaining the current situation without addressing the hydrocephalus, suggesting that treatment might lead to complications.
He also visited China Medical University in Taichung, where the doctor provided similar advice, recommending continued medication.

I would like to ask, based on my research, if hydrocephalus can also lead to dementia.
My father has dementia but does not exhibit symptoms such as unsteady gait or incontinence.
Could this be related to hydrocephalus? If the hydrocephalus is causing brain damage and it is not Alzheimer's disease, would it be better to address the hydrocephalus? Are there really significant risks of severe complications? Is the risk high? Would you recommend testing for Alzheimer's disease? Could you suggest suitable medical facilities in central Taiwan that can manage hydrocephalus or test for Alzheimer's disease? (If there are better hospitals in other regions, that would also be helpful.) Thank you very much!

Niming, 20~29 year old female. Ask Date: 2021/10/12

Dr. Hong Weibin reply Neurology

Hello: Diagnosing dementia requires not only imaging studies but also a thorough assessment of the patient's clinical symptoms and disease progression to make an accurate diagnosis.
Generally, if dementia is caused by normal pressure hydrocephalus, the patient often presents with gait instability, which may later be accompanied by urinary incontinence.
If the initial symptoms of the patient are primarily memory decline and communication difficulties, without significant gait instability developing over several years, cortical dementia remains the most likely diagnosis.

If there is a strong desire to confirm whether the dementia is due to Alzheimer's disease, a patient can opt for an out-of-pocket amyloid PET scan, which is currently primarily used for research purposes and is not covered by insurance, costing approximately tens of thousands of NT dollars.
Most major medical centers in the country (such as China Medical University in Taichung and Taichung Veterans General Hospital) should have this equipment available.
If amyloid deposits are found in the brain, the likelihood of Alzheimer's disease causing the dementia significantly increases.
The diagnosis and management of normal pressure hydrocephalus typically begin with a lumbar puncture, a commonly used diagnostic procedure.
The patient is positioned in a lateral decubitus position, and a needle is inserted at approximately the L3/L4 vertebral level to withdraw about 30-50 ml of cerebrospinal fluid.
Following this, the patient's cognitive function and gait should be monitored for improvement.
If the condition is indeed normal pressure hydrocephalus, the patient's gait and incontinence should gradually improve within a few days.
Subsequently, a referral to neurosurgery may be considered for the placement of a ventriculoperitoneal (VP) shunt or a lumboperitoneal (LP) shunt.
These procedures require general anesthesia and should not be difficult for a neurosurgeon to perform.
洪煒斌

Reply Date: 2021/10/12

More Info

Understanding dementia and hydrocephalus, especially in the context of your father's condition, is indeed complex and requires a nuanced approach. Your father's diagnosis of early-onset dementia, coupled with the presence of hydrocephalus, raises several important considerations regarding his cognitive decline and overall health.

Dementia and Hydrocephalus
Dementia is a broad term that encompasses various conditions characterized by cognitive decline, including memory loss, impaired reasoning, and difficulties with communication. Early-onset dementia, as seen in your father at the age of 63, can be particularly challenging, as it often affects individuals in their prime working years and can have significant implications for their families and caregivers.

Hydrocephalus, on the other hand, refers to an accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, which can lead to increased intracranial pressure and potentially cause brain damage. The relationship between hydrocephalus and dementia is significant; in some cases, hydrocephalus can lead to a specific type of dementia known as normal pressure hydrocephalus (NPH). NPH is characterized by a classic triad of symptoms: gait disturbance, urinary incontinence, and cognitive dysfunction. However, not all patients with hydrocephalus will exhibit these symptoms, and your father's lack of gait instability or incontinence does not rule out the possibility of hydrocephalus contributing to his cognitive decline.

The Impact of Hydrocephalus on Cognitive Function
The question of whether the hydrocephalus is causing the cognitive decline or if the dementia is leading to hydrocephalus is a critical one. In some cases, treating the hydrocephalus—typically through the placement of a shunt to drain excess CSF—can lead to improvements in cognitive function. However, this is not guaranteed, and the decision to intervene surgically must be weighed against the potential risks, including infection, bleeding, and the possibility of over-drainage, which can lead to further complications.

Your father's current treatment with medications like donepezil (often referred to as "愛憶欣") is aimed at managing symptoms of dementia, particularly in Alzheimer's disease. While these medications can provide some symptomatic relief, they do not address the underlying causes of hydrocephalus.

Recommendations and Next Steps
1. Consultation with a Specialist: Given the complexity of your father's condition, it may be beneficial to seek a second opinion from a neurologist or a specialist in dementia and hydrocephalus. They can provide a more comprehensive evaluation of his cognitive function and the impact of hydrocephalus.

2. Imaging Studies: Follow-up imaging, such as MRI or CT scans, can help assess the progression of hydrocephalus and any changes in brain structure. This information is crucial in determining whether surgical intervention is warranted.

3. Cognitive Assessment: It may be helpful to conduct formal cognitive testing to assess the extent of your father's dementia. This can provide a clearer picture of his cognitive abilities and help guide treatment decisions.

4. Supportive Care: Engage with support groups or resources for families dealing with dementia. This can provide emotional support and practical advice for managing daily challenges.

5. Potential Treatment Options: If hydrocephalus is confirmed to be contributing to cognitive decline, discussing the risks and benefits of shunt placement with a neurosurgeon may be appropriate. They can provide insights into the likelihood of improvement and the associated risks.

Conclusion
In summary, your father's situation is multifaceted, involving both dementia and hydrocephalus. While hydrocephalus can contribute to cognitive decline, the decision to intervene surgically must be made carefully, considering the potential benefits and risks. Seeking specialized care and conducting thorough assessments will be key in managing his condition effectively. If you are looking for specific medical facilities in central Taiwan that specialize in these areas, consider contacting major medical centers or universities with neurology and neurosurgery departments, as they often have the resources and expertise to handle complex cases like your father's.

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