Expert: Mary Gordon - 5/31/2007

Question
Mary
My mother is 80 years old will turn 81 in July. Her diagnosis of Dimentia was determined in April 2005.  I noticed that her MRI read noted ischemic deep white matter disease noted, otherewise MRI is normal.  We put her in an assisted living home for Alzheimers in April 2007, she does quite well with the other individuals, but I had begun reading about NPH Normal Pressure Hydrocephalus and my Mom (prior to being diagnosed with dimentia) had several spine surgeries in which she developed a staph infection, could it possibly be thatthe spinal fluid is NOT getting to her brain for oxygen?  She is not on any medicine except for 2350 miligrams depaokote and .5 mg ativan (PRN up to 4 xs) and she does get frustrated, but her memory seems better being in the home then being at home with us.  She recognizes me when I come visit, where at home she had not known me for about 1 1/2. Also, she had all of her teeth pulled out in 2003, and lost 40 pounds ( has since put it back on) but could that have caused some type of imbalance in the brain.  It is not that I am in denial of her disease, I just want to make sure they have the right diagnosis made, do you think it would be worth checking out the NPH for further evaluation?
Thanks
Karen  

Answer
Hi Karen, your mother's doctor should have taken the time to explain things better. "Dementia" is a term like "fever". It is a word that describes a symptom, not the underlying CAUSE of the symptom.  After all, if the doctor says you have a fever, you say - well, I knew I have a fever, but what is CAUSING the fever.

So your mom being described as having a dementia is NOT a diagnosis. It must means that the doctor could see that she had some serious cognitive impairments (i.e. she was having memory problems, was confused, couldn't think clearly. A diagnosis would have told you what the confusion was caused by - and there are many diseases that cause dementia.  

"Ischemic white matter disease" means that on the MRI, they could see damage to the "white" matter or the myelin of the brain, probably caused by small blockages in blood vessels. This kind of damage is usually associated with vascular dementia (ie.. dementia that has developed due to accumulated damage from dozens of tiny strokes or blockages).

"Ischemia" means inadequate blood supply (circulation) to a local area due to blockage of the blood vessels to the area.  So what your mother actually has is much more likely to be something like Binswanger's disease, rather than "Alzheimer's". These vascular dementias are sometimes classed as  "multi-infarct" - infarct just means blockage. It could also be, as you were wondering, from normal pressure hydrocephalus - but that would often present itself with three big symptoms right near the start - incontinence, problems walking, and confusion.

Here is some information about Binswanger's.
http://www.ninds.nih.gov/disorders/binswangers/binswangers.htm

Here is some information about NPH (sometimes called Hakim syndrome or Hakim's Disease)
http://www.aafp.org/afp/20040915/1071.html

Now, having been told your mother probably has dementia from something other than Alzheimer's doesn't mean that the outcome can be any different. There really isn't much they can do about multi-infarct/Binswangers other than try to keep the person's blood pressure under control, and make sure they are as healthy as possible in other ways.  

You might want to book an appointment with the doctor to have him or her go over the results more carefully with you, and answer your questions.

However, it does sound like she is very likely to have a progressive, incurable disease that will cause her to decline, and it is unlikely there is much that can be done to slow it down. However, the doctor does owe it to you to explain the results of the tests to you, what he thinks the real cause is, and what the prognosis is.  

Your mom is lucky to have you looking out for her. Give the doctor a call.

Mary