When we reviewed week’s lay article about “New hope for
Alzheimer’s sufferers after new treatment ‘restores memory in minutes’”, it
reminded me of an episode of Body of Proof that I had watched over winter
break. Long story short of the episode, among the drama of a murder of course,
one of the family members of the victim was being treated for Alzheimers, but
the protagonist doctor discovered that he was actually misdiagnosed for a CSF
buildup (if I recall correctly), gave him medicine, and he was recalling
memories instantly.. So I wanted to see if this was a real thing and not
something that Hollywood made up!
Normal pressure
hydrocephalus (NPH) is the name for this abnormal cerebrospinal fluid buildup. It
is often misdiagnosed as other diseases such as Alzheimer’s or Parkinson’s due
to overlapping symptoms such as difficulty with walking, urinary inconsistence,
or cognitive changes. Under certain conditions, some patients are candidates
for surgical treatments, allowing more flow of the fluid and in turn allow
those patients to regain some of the functioning that was lost. (http://www.webmd.com/brain/normal-pressure-hydrocephalus)
I could not find, however, how quickly one would regain that
cognitive ability. I’d imagine that with surgery, it would take a while before
regaining memories or complete physical activity. In regards to the lay
article, I feel that if Enbrel really was a miracle drug and allowed patients
to regain their cognitive ability so quickly, we would hear about its use a lot
more. The one thing I found interesting
in both circumstances was the importance of flow to the brain: CSF in NPH, and
blood flow to the brain ‘where the drug is designed to block a chemical
responsible for inflammation’ with Enbrel. I now question whether the subjects in
the Enbrel article were confirmed with a brain scan as Alzheimer’s patients or
whether it was a misdiagnosis and a coincidence that these results were found.
Woah, I've definitely never heard of Normal Pressure Hydrocephalus (NPH). I was curious to see how many people are thought to live with NPH and was surprised to find out that 5-10% of all dementia cases are thought to be caused by this disorder. (Source: http://www.lifenph.com/faqs.asp)
ReplyDeleteIt was also noted on the website that one of the first symptoms that patients experience is the feeling of having their feet stuck to the floor (source: http://www.lifenph.com/screening-test.asp). However, what a odd symptom. I don't know if I would go to the doctor with such a vague symptom. I would argue that by the time the disease has progressed to the point of blocking memory, the patient probably can't recall that their feet felt stuck to the floor a year back.
It's a bit scary that there may be a significant number of dementia patients out there who live with this reversible disease. It seems that this is one such case where patients and their families must advocate for themselves to make sure that NPH was properly ruled out.
I found this study and it seems as if they haven't really separated the two conditions. The American Association of Neurological Surgeons, created the study called,"Elucidating the Etiology of Normal Pressure Hydrocephalus (NPH) and the Spectrum of Surgically Treatable Dementias"to see if NPH and A.D. really have medical connections by Sebastian F. Koga, MD of University of Virgina. So The proliferation of beta-amyloid plaque is best evidence that Alzheimer's is developing.Since beta-amyloid protein accumulation leads to an inflammatory responds and the remains of nerve cells and fibers, get clogged up with beta-amyloid. In a big effort to "evaluated CSF (biomarkers beta-amyloid, T-tau, P-tau, APOε4 genotyping) and correlated these to cortical histopathology samples and neuropsychological outcomes." In the first fifty patients they concluded that, The higher abundance of neuritic plaques and beta-amyloid in CSF the higher the failure rate. The more plaques in the biopsies would indicate an advanced form of Alzheimer's in most of their patients. The analysis of the CSF biomarkers show edvidence that NPH "progression mirrors the changes seen in patients with Alzheimer's." Which pushes people to research this area, so that if you can catch NPH early you can delay the symptoms. From Dr. Koga "This study further elucidated that NPH is a surgically treatable form of dementia in many cases, and must be considered in the spectrum of tau-proteinopathies. Further in-depth studies are indicated."
ReplyDeletehttp://www.sciencedaily.com/releases/2012/03/120330123056.htm
ReplyDeleteResearchers have identified Serum Amyloid P component (SAP) in Alzheimer's patients. The component binds to fibrils of amyloid beta, essentially anchoring it in place. SAP is also associated with aluminum, which has been shown to be in higher concentrations in AD patients. The next step of AD treatment research involves targeting SAP so that it can no longer bind to amyloid beta.
Perhaps if the treatment is effective for AD, it can be used for NPH as well!