Wet, wobbly, and wacky ~ Looking for Normal Pressure Hydrocephalus in our older patients


Gait troubles, incontinence, and dementia / wobbly, wet, & wacky

Bob Fowler, the subject of this 60 minutes special, presented with this triad of symptoms and was ultimately diagnosed Alzheimer’s disease. He had been to doctor after doctor, and suffered with debilitating symptoms for nearly a decade including trouble walking, incontinence, and severe memory deficits & dementia.

Then he had an MRI and CAT scan, the results showed he had NPH. Which is caused by excess fluid putting pressure on the brain causing the exact symptoms suffered by Mr. Fowler –> known as the classic triad of NPH symtoms (wet: incontinence,  wobbly: gait difficulties, mostly shuffling, and wacky: dimentia and memory deficits). In the geriatric population, a surprising number of cases go undiagnosed or misdiagnosed as Alzheimers or even Parkensons. It is estimated that up to 5% of individuals with an Alzheimer’s diagnosis may actually have NPH. What is really shocking is that NPH, unlike Alzheimers is treatable! With a simple surgery (providing a shunt that drains fluid from the brain) Bob Fowler and other patients like him can live out their golden years symptom free!

This just goes to show how CRUCIAL patient centered care is, we can’t just focus on what we know or what is expected…after all we may be missing that 5%.

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