|Abbreviated Mental Test Score (AMTS)
| Dementia with Lewy bodies
| Frontotemporal dementia
| Corticobasal degeneration
| Creutzfeldt Jakob disease
| Vascular Dementia
| Primary progressive aphasia
| Anti Dementia Drugs
| AIDS Dementia Complex
| Normal Pressure Hydrocephalus
| Acetylcholinesterase inhibitors
| Mental Capacity Act 2005
| Behavioural and Psychological Symptoms of Dementia
The popularity of the diagnosis seems to be wanning. Problem is that the clinical triad is very common as is ventricular enlargement due to cerebral atrophy and it is difficult to tease out the NPH patients who will benefit from shunting which has itself significant complications.
- It may be due to reduced CSF absorption at the arachnoid villi
- Seen in the elderly first described in 1965
- Potentially reversible cause of dementia
- Selecting those for shunting is difficult
- Idiopathic in most cases
- Secondary causes: head injury, meningitis, SAH, CNS tumour
- Damage to fibres that supply legs and bladder
- Can be cortical or brainstem compression
- Much is unclear and theoretical
- No Headache and No Papilloedema
- Slowly Progressive worsening gait disorder
- Apathy, personality change
- Progressive Dementia, Urinary incontinence
- A common set of symptoms
- Exclude other causes of dementia and gait disorder
- LP shows normal CSF opening pressure
- CT shows dilated ventricles with a lack of cortical effacement. Ventricular dilation is more advanced than cortical loss. However many disorders can cause cognitive impairment, a gait disorder, and urinary incontinence, and virtually all neurodegenerative diseases lead to ex-vacuo dilatation of ventricles (enlarged ventricles due to loss of brain tissue)
- MRI: also shows periventricular hyperintensity from transependymal CSF flow
CT scan of NPH
- Expert evaluation for diagnosis.
- Assess changes seen after removing 40 mls CSF in Gait and Neuropsychiatric testing 3 hours following LP. If positive this suggests possible benefits from shunting. Often times there is no distinct benefit.
- Once shunted - ventriculoperitoneal shunt the ventricles often shrink in size.
- Improvement is seen in 20-90% depending on case selection.
- Complications from shunting include bleeding, infection, SDH, hypotension headaches. So care must be taken to weigh risks and potential benefits.