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'Alzheimer's Impostor' Hits 375,000 with Reversible Illness

By Kleyman, Paul | Aging Today, November/December 2004 | Go to article overview

'Alzheimer's Impostor' Hits 375,000 with Reversible Illness


Kleyman, Paul, Aging Today


Robert G. "Bob" Fowler, at age 73, is a hale and strapping lifelong oilman, the 1988 inductee into Texas industry's Roughneck Hall of Fame. Today the former president and chairman of Enserch Exploration Inc., parent company of Lone Star Oil and Gas, runs RGG investments with his son, Bob Jr. He hunts and golfs enthusiastically, travels extensively, devotes as much time as possible to his granddaughter-and is generally ambulatory after nearly a decade of deterioration that left him misdiagnosed with Parkinson's and Alzheimer's. Fowler is also an avid and articulate evangelist spreading the news about Normal Pressure Hydrocephalus (NPH), sometimes called the Alzheimer's impostor.

"In the early '90s, I started having a variety of problems that were irritating, confusing and troublesome," Fowler told a press gathering earlier this year. He would inexplicably stumble and fall, his hand-eye coordination waned and he lost physical dexterity. Urination became so frequent and urgent that it seemed as if Dallas golf courses lacked "enough trees to handle some of those emergencies." His attention span shortened, and waves of drowsiness endangered his safety when the sound of a car began lulling him to sleep. On a drive to Houston, Fowler dozed off with the cruise control set to 70 miles per hour. He woke up careening down the middle of a roadside ditch. Miraculously, he was able to brake the car without damage or harm to himself and his wife, Bonita.

WAKE-UP CALL

Fowler was among speakers at a presentation held by the National Council on the Aging (NCOA) earlier this year. "What if one in 20 or as many as one in 10 people diagnosed with dementia in fact have a reversible, treatable condition?" asked NCOA president and CEO James P. Firman. The news that NPH, once called water on the brain, often can be cured if correctly diagnosed "should be a wake-up call to the medical community, caregivers and long-term care providers to be on the lookout for it." Most people who develop NPH are over age 60, with the median age of onset being the early 70s.

When Firman first learned about NPH last year, he was alarmed to discover that almost none of the experts in assisted living or adult daycare he talked to had heard of the ailment. Firman said his mother's diagnosis last year with what turned out to be vascular dementia made him especially sensitive to the need for public awareness about any glimmer of hope patients and their families might have that at least some dementia is reversible. He added, "We need to make sure that the symptoms of NPH are recognized as early as possible to avoid sending patients down the wrong path."

Dory Kranz, director of NPH and Older Adult Services at the Hydrocephalus Association in San Francisco, observed, "The lucky ones like Bob Fowler are able to be their own health advocates or have a loved one advocating for them. They keep asking the same questions of different doctors until they find out what's wrong." Although only 11,500 people last year had the surgery that can repair NPH, she said an estimated 375,000 people, or about 5% of those diagnosed with dementia, actually have the ventricles in their brains ballooned with excessive cerebrospinal fluid (CSF). This fluid frequently can be drained with a surgically implanted shunt to restore a patient's ability to function. "With proper treatment, the vast majority can transform from being an embarrassment to themselves and a burden to their families-perhaps in or on their way to a nursing home-back to being contributing members of society," she said.

THE HARD WAY

Kranz added that she learned of NPH the hard way, through the experience of her father-in-law, Dick Kranz. It took at least six years from the onset of his gait problems and related difficulties to get a correct evaluation. A brain scan is critical in determining whether a patient at risk for NPH actually has this condition. In fact, Dick had a brain scan in 1992, but the radiologist was looking for a carotid artery problem and "failed to recognize the enlarged ventricles," she said.

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