Expert: Paula Damgaard - 6/4/2006

Question
Hi Paula,

I have a question regarding my friend's father -- he was diagnosed with Alzheimer's Disease and Parkinson's.  However, we have doubted that this is what he truly has.  Some of the symptoms seem to be more related to a condition known as NPH.  (I don't know if you've heard of it before.)

This website lists ALL of his symptoms: http://www.nlm.nih.gov/medlineplus/ency/article/000752.htm#Symptoms

I know that most of them either fall into the category of Parkinson's or Alzheimer's as well, but it just doesn't seem right for him to have every single one of them, but no other symptoms from either of the other conditions (?).  His MRI also showed enlarged ventricles to the brain (that's what a person with NPH's MRI would supposedly show).  Also, lately he has been making a noise, similar to a cat meowing.  He makes it constantly and involuntarily.  For example, he'll be trying to talk to you, (mind you in a very regressed manner, almost at the level of a child), and then at the end of a word, he'll make that noise, but then try to repress it by speaking louder.  It's very difficult to explain, but it's definintely involuntary and he does it 29-30 times a minute.

Does this sound like something that Alzheimer's patients do?  Or Parkinson's?  I didn't think that it did, and I couldn't find any information on it, but I figured that I'd ask someone with more knowledge on the subject than I have.  So if you could please give me any information on this, I'd greatly appreciate it.  Thank you and take care!

Answer
Julie, the symptoms you are asking about could very well be related to his Parkinsonism.  Unfortunately, they seem to develop this as the disease wears on.  Having enlarged ventricles may be a sign of NPH but without knowing what other symptoms he has, it could be a result of his AD/PD.  If he hasn't seen a good neurologist, then I would suggest that he go to one.  If he feels that it may be NPH, he would most probably set him up for what is called a high volume lumbar puncture.  This would envolve him having a spinal tap, where they would take out a good bit of spinal fluid, if he had NPH, this would cause an immediate reaction, indicative of the disease, then they would have a shunt placed.  If he showed no improvement, then that would mean he has no NPH.  

Unfortunately, even though people get some relief from their NPH with the shunt placement, it just seems to me that they later develop a dementia, whether it be connected to AD or AD/PD, but this is just my personal observation, nothing that I could point you to a literary search for.

I hope this helps.  Good luck.  Paula