When an older adult becomes unsteady and forgetful, it’s tempting to blame age—but occasionally those symptoms point to something doctors can actually treat.
Billy Joel recently revealed more about his diagnosis of normal pressure hydrocephalus, or NPH, and the brain surgery he underwent to treat it. The musician described problems with balance and a rocking sensation before receiving his diagnosis and later having a shunt implanted. He also reported improvement afterward. His experience highlights an important medical reality: some conditions can mimic aspects of dementia or age-related decline without being typical neurodegenerative dementia.
What is normal pressure hydrocephalus?
The brain and spinal cord are surrounded by cerebrospinal fluid, or CSF. Normally that fluid circulates and is absorbed. Hydrocephalus occurs when excess CSF accumulates in spaces called ventricles inside the brain.
With NPH, this buildup happens gradually. Despite the name, diagnosing the condition involves more than simply measuring “normal” pressure. The National Institute of Neurological Disorders and Stroke says NPH can cause problems with walking, bladder control, thinking and reasoning and is most common in older adults.
Walking problems can be an important clue
One characteristic feature is a change in gait. Someone may become slow or unsteady, have trouble initiating steps or seem as though their feet are stuck to the floor. Falls may become more frequent.
At the same time, family members may notice problems with attention, thinking or memory. Urinary urgency or loss of bladder control can also develop. Because all three problems become more common for many reasons as people age, the pattern can easily be attributed to unrelated age-associated changes.
It can resemble dementia
The National Institute on Aging lists normal pressure hydrocephalus among medical conditions capable of causing dementia-like symptoms. That’s important because Alzheimer’s disease and many other neurodegenerative dementias currently can’t be reversed. NPH is different.
For appropriately selected patients, draining excess cerebrospinal fluid through a surgically implanted shunt may improve symptoms. Not everyone improves, and surgery carries risks, but the possibility of treatment makes accurate diagnosis particularly important.
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Not every memory problem is dementia
There are other reasons cognition can change, too. Medication side effects, thyroid disorders, vitamin deficiencies, depression, sleep disorders, infections and other medical conditions can sometimes produce cognitive symptoms. That doesn’t mean every episode of forgetfulness needs an exhaustive neurological workup.
Occasionally forgetting a name or where you left your keys is very different from a progressive change affecting everyday functioning. But new cognitive changes accompanied by significant alterations in walking or bladder control deserve medical attention.
Age can become an explanation too quickly
Joel made an observation many older adults will recognize: it can be difficult to know what’s age and what’s a medical condition. That uncertainty can cause people to normalize symptoms that are actually worth investigating. Getting older does bring physical and cognitive changes. But age itself isn’t a diagnosis.
A sudden or significant deterioration in balance, thinking, mobility or continence shouldn’t automatically be dismissed because someone happens to be 70 or 80. Sometimes asking “Is this really aging?” can uncover a condition nobody was looking for.
Have you ever had a symptom you initially blamed on getting older that turned out to have another explanation?
