Dear Dr. Roach: I am an 84-year-old woman who was recently diagnosed with hydrocephalus after an MRI scan. I understand that there isn’t any treatment besides a shunt. Do you have any recommendations? I do not want to go through this procedure.
R.R.
Normal pressure hydrocephalus (NPH) is an uncommon problem most commonly found in people over 60. There are three types of symptoms that are found in NPH: changes in a person’s walking; memory loss as well as other mental changes; and urinary incontinence. The typical change in walking is moving slowly with small steps, often with the feet more widely apart than the previous gait. The gait abnormality is essential in making the diagnosis.
Neurological changes sometimes resemble Alzheimer’s, especially in what is called “executive function” — the ability to synthesize information and formulate a plan. Decreased attention and apathy can develop. The pace of neurological changes is slow, ranging from months to years.
Urinary urgency, the sense of needing to get to a bathroom right away, can lead to incontinence due to the slow gait, but when the condition is more advanced, a person can have apathy and not really care that they are having incontinence.
An MRI is essential for the diagnosis, but without symptoms (you didn’t mention any), even abnormal findings on the MRI are insufficient to make the diagnosis. A shunt would not be indicated quite yet. In people with an MRI showing hydrocephalus and compatible symptoms, a lumbar puncture is performed. The pressure is measured, and if it is normal, fluid is taken off to see whether the person’s gait improves immediately at home over the next few days.
Only when all of the diagnostic criteria are fulfilled and the person clearly gets better after fluid removal is a shunt considered. The gait is most likely to improve with a shunt. Advanced neurological changes often do not get better, which is why making the diagnosis and beginning treatment quickly is important.
Finally, the shunt isn’t perfect. It significantly improves symptoms for about 75% of people. Shunt blockages and infections are possible complications.
Dear Dr. Roach: I have been on a daily low dose of acyclovir for years to prevent a flare-up of a herpes keratitis ulcer in one of my corneas. I read somewhere that antivirals like acyclovir may help prevent Alzheimer’s. Is there any truth to this?
P.N.
Among people with active or latent herpes, treatment with acyclovir and similar drugs was found to reduce dementia risk by about 10%, compared to no treatment. It is thought that herpes infections may have something to do with the beta-amyloid plaques found in the brains of people with dementia. I do want to emphasize that this is only for people with known herpes infections, such as genital herpes or shingles.
It’s also interesting that getting the shingles vaccine also seems to protect people against dementia, probably by preventing the herpes virus from getting into the brain to begin with. In one study, the vaccine reduced dementia risk by 20%. It’s very clear that dementia is a lot more complicated, and there isn’t going to be one perfect cure, treatment or prevention. Acyclovir may be a small help for some people, but a healthy, mostly plant-based diet and regular exercise remains the best prevention.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
