yourself counting to 4. Now somebody just got dementia

Around 35 million people suffer from this terrible disease. There are many types of Dementia. One of them

is, Normal-pressure Hydrocephalus. Hydro, meaning water, and cephalus meaning brain.

So a watery brain, or more specifically, cerebrospinal fluid, this blue color accumulates in the

brain. Why? The cerebrospinal fluid is continuously produced

in the ventricles. It travels within the subarachnoid space, this blue color and reaches the arachnoid

granulations which absorb the cerebrospinal fluid and transfer it to the brain sinuses,

which remove the fluid from the brain. BUT in this disease there are problems with

absorption in the arachnoid granulations, so the cerebrospinal fluid can not be removed

properly. Now if you know physics, you would argue that if the fluid is continuously produced,

not removed, then the pressure should increase in the brain. And you are correct, the pressure

slightly increase. BUT stays in the normal range. Why? because the brain is soft, so

it gets compressed. Where? In the ventricles, so these will dilate. We can see this dilation

with neuroimaging, like CT scan or MRI. This is one indication for diagnosing Normal-pressure

hydrocephalus. But we need more information for diagnosis, because the ventricles can

be dilated due to other reasons too.

First of all, we can check symptoms. What is the patient complaining about?

Pay attention to 3 symptoms, Gait problems, meaning that the balance of the patient is

bad. We can typically see magnetic gait, that looks like the patients feet are pulled by

a big magnet in the floor. If you are curious what I mean, just check out youtube videos

showing patients with magnetic gait.

Second symptom, is urinary incontinence, and third, we have dementia.

Dementia happens usually late in the disease. The early signs of dementia are impaired attention

and executive functions, like problem solving, planning, reasoning etc. The late signs of

dementia are impaired memory.

Vascular dementia, another type of dementia can also have these 3 symptoms. So symptoms

are not enough of diagnosis

All 3 symptoms are somehow related to the nervous system. Remember that the cerebrospinal

fluid accumulates and that it compresses the brain? So lets try to remove this fluid and

see if it gets better. We will use a method called Lumbar puncture,

also called spinal tap. Here we remove 30-50 ml of cerebrospinal fluid. It will in a couple

of hours lead to an improvement in gait, continence and cognition, and now we know that it is

Normal-pressure hydrocephalus.

The next step is then, to treat it with ventriculoperitoneal shunting. This means that we put a tube into

the brain ventricle and let the tube enter into the peritoneal cavity, meaning into the

abdominal region. In this way the cerebrospinal fluid flows into the abdomen, so the pressure

can not build up in the brain, and therefore the patient does not feel the symptoms anymore.