From: hounddog23x@gmail.com   
      
   Her mother seemed to have classic dementia. Or did she?   
       
   The author’s mother with her granddaughters. The retired psychiatrist’s   
   cognitive symptoms improved immedateily after brain surgery two years ago.   
   (Family Photo)   
   By Roni Caryn Rabin March 2   
   When my mother, Pauline, was 70, she lost her sense of balance. She started   
   walking with an odd shuffling gait, taking short steps and barely lifting her   
   feet off the ground. She often took my hand, holding it and squeezing my   
   fingers.   
      
   Her decline was precipitous. She fell repeatedly. She stopped driving, and she   
   could no longer ride her bike in a straight line along the C&O Canal. The   
   woman who taught me the sidestroke couldn’t even stand in the shallow end of   
   the pool. “I feel    
   like I’m drowning,â€� she’d say.   
      
   A retired psychiatrist, my mother had numerous advantages — education,   
   resources and insurance — but, still, getting the right diagnosis took   
   nearly 10 years. Each expert saw the problem through the narrow prism of a   
   single specialty. Surgeons    
   recommended surgery. Neurologists screened for common incurable conditions.   
   The answer was under their noses, in my mother’s hunches and her family   
   history. But it took a long time before someone connected the dots.   
      
      
   My mother was using a walker by the time she was told she had a rare condition   
   that causes gait problems and cognitive loss, and is one of the few treatable   
   forms of dementia.   
      
   The bad news was that it had taken so long to get the diagnosis that some of   
   the damage might not be reversible.   
      
       
   The author’s mother at her graduation from medical school in South Africa.   
   (Family Photo)   
   â€œThis should be one of the first things physicians look for in an older   
   person,â€� my mother said recently. “You can actually do something about   
   it.â€�   
      
   â€˜Did Mom tell you? She fell again.’   
   The falls started in 2004. My mother fell in the bedroom of her Bethesda home.   
   She fell in the airport while returning from a trip to see my sister.   
   Sometimes she told me, and sometimes a sibling would call or e-mail. “Did   
   Mom tell you? She fell again.â   
   €�   
      
   Millions of older adults fall every year; in my mother’s case, it was her   
   gait that tripped her up. It became uneven. She was unsteady; the slightest   
   incline threw her off stride. Sometimes she quickened her pace involuntarily,   
   and she sometimes bent    
   over, then straightened back up.   
      
   She went to doctor after doctor. “I want a diagnosis,â€� she would say   
   before the next appointment with a neurologist, geriatrician, urologist or   
   orthopedist. “I’m convinced this is something organic — that it has an   
   underlying biological cause.†  
   �   
      
      
   A series of neurological evaluations ruled out the obvious suspects: My mother   
   didn’t have the tremor typical of Parkinson’s, a devastating, progressive   
   disorder, and she did well on cognitive tests, which eliminated Alzheimer’s   
   disease.   
      
      
   Next, my mother went to see an orthopedic surgeon. He said she had stenosis,   
   or narrowing of the open spaces of the spine, and recommended surgery. She   
   underwent a complicated, potentially dangerous back operation, and she seemed   
   to be walking more    
   smoothly afterward — for a few months.   
      
   Other symptoms   
   She developed other symptoms. Perhaps because she wasn’t exercising, her   
   blood pressure went up. She gained weight and was at risk for diabetes. She   
   developed a persistent hacking cough, but no one could identify the cause: Her   
   lungs were clear.   
      
   She was also having trouble getting to the bathroom on time, so she had more   
   surgery, this time to implant mesh designed to alleviate urinary incontinence.   
   Medicare and private insurance picked up the tab, but once again the relief   
   was temporary.   
      
   My mother had always been terrified she would lose her memory. Her mother,   
   Helen, who died in 1988, spent the last five years of her life bedridden,   
   unable to walk and oblivious to her surroundings. Any physician who took a   
   careful family history would    
   learn that my mother had long suspected that Helen’s dementia was caused by   
   normal pressure hydrocephalus, or NPH, a buildup of cerebrospinal fluid in the   
   brain that causes difficulty walking, urinary incontinence and cognitive loss,   
   in that order.   
      
   When my mother met with specialists, she floated the idea that she might have   
   NPH. In some ways she hoped that was the diagnosis, because it often can be   
   treated by implanting a small shunt into the brain to drain off the excess   
   fluid.   
      
   Another neurological evaluation that included MRI scans of the brain revealed   
   that my mother had enlarged ventricles. Ventricles are the cavities in the   
   brain that are filled with cerebrospinal fluid, and their enlargement   
   suggested any number of    
   conditions, including brain atrophy and Parkinson’s. They are also   
   considered a red flag for NPH.   
      
      
   A neurologist in Bethesda did briefly consider NPH. He did a spinal tap to   
   withdraw a small amount of cerebrospinal fluid but ruled out the diagnosis   
   when he saw no immediate improvement in my mother’s gait. But he may not   
   have withdrawn enough fluid    
   to see a change, experts told me.   
      
   One feature of NPH is passivity. My mother was forgetful at times, but what   
   was more striking was her lack of initiative. She didn’t make plans as she   
   used to. She’d start a knitting project and drop it. She may have been less   
   aggressive than normal    
   about pursuing her hunch about the source of her trouble. “One doctor told   
   me, ‘This doesn’t run in families,’ â€� she said.   
      
   Two years ago, doctors finally got it right.   
      
   My mother and stepfather had gone to visit friends in Gainesville, Fla. They   
   urged her to make an appointment at the University of Florida’s Center for   
   Movement Disorders and Neurorestoration. Doctors there suspected NPH as soon   
   as they saw my mother    
   walk across the room. They recognized the shuffling gait and what they call   
   â€œmagneticâ€� footsteps that seemed glued to the floor. They ordered   
   additional tests, including a spinal tap to see if her walking improved after   
   a large amount of    
   cerebrospinal fluid was withdrawn — it did — and another imaging scan to   
   rule out the possibility that the buildup was caused by an obstruction, such   
   as a tumor.   
      
   Inserting a shunt is a dangerous operation: A thin tube is implanted in the   
   brain to drain excess cerebrospinal fluid and release it into the abdomen.   
      
      
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