Expert: Mary Gordon - 6/4/2006

Question
Hi Mary,

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
Hi Julie,

What you are describing would be described as a verbal tic, and no, its not a routine part of Alzheimer's. Having said that, many people with AD do develop all kinds of weird symptoms due to their brain damage (such as repeating a particular phrase over and over).

Having said that, if the alarm bells are going off in your gut, I'd listen to them. You really need to talk to his doctors to make sure his dementia was properly evaluated and diagnosed, and to ensure they specifically ruled out something potentially treatable like NPH. You are absolutely doing the right thing to question their diagnosis - ask lots of questions and be insistent and persistent. You will never forgive yourself if you end up with uncertainty in your mind regarding whether that he might have had something treatable and you didn't take action to rule it out.

As I know you know, NPH is often missed, or misdiagnosed, and doctors can be less than scrupulously careful in their examinations of the elderly (i.e. if you were having his symtpoms at 50, doctors often are much more alarmed and thorough than they are with an older patient - sometimes they kind of right you off as though senility is normal and to be accepted). Don't let them put you off if you believe they have not properly checked out his problems.

Enlarged ventricles are often a sign of normal pressure hydrocephalus, but you can also see the same thing in Alzheimer's patients as well as patients with some other dementias - sometimes from brain deterioration (i.,e. shrinkage).

Here is some good information on NPH and how it can be diagnosed and evaluated. http://psyweb.com/NPH/nph.jsp
Here is a comparison and overview of various causes of dementia
http://www.memorydisorder.org/patientcare/dementiafaqs.htm
(couple of good links to NPH information as well)

You will note that a good way to see if pressure is causing the problem is to do a lumbar puncture and remove some fluid (i.e. to see if symptoms are even temporarily relieved). Even if your father has NPH, not everyone with this can be helped by a shunt - however, its ALWAYS worth being sure you know what the underlying cause of his problems is.

Hang in there - you are doing exactly what a caregiver is supposed to do - act as an advocate for your loved one and ensure he is properly evaluated and  gets appropriate treatment and care.  

Mary G.