It is difficult to decipher the motivation to diagnose dementia with undignified haste by the present government when there is no real "cure" to speak of. The Cockroach Catcher was brought up to aim to diagnose treatable conditions than incurable ones. It is therefore not unreasonable to suspect that there are different motives: from refusing certain treatment such as hip replacement or organ transplants to promoting dementia medications by big pharmas.
In all the hasty announcements including paying GPs a fee for making such a diagnosis, no mention was made of a diagnosis that mimic dementia.
© Am Ang Zhang 2014
Thirty years ago, I saw mountains as mountains, and waters as waters.
When I arrived at a more intimate knowledge, I came to the point
where I saw that mountains are not mountains,
and waters are not waters.
Thirty years on,
I see mountains once again as mountains, and waters once again as waters.
NPH: Normal Pressure
Hydrocephalus
Normal pressure hydrocephalus (NPH) is a relatively
new neurologic disorder of elderly patients described by Salamon Hakim in
Spanish in a thesis in Bogotá ,
Colombia
The precise pathogenesis of NPH is not known, but it
is well-known that despite the absence of increased intracranial pressure, the
drainage of cerebrospinal fluid (CSF) regularly induces transient clinical
improvement, and ventriculosystemic shunting (VSS) usually results in prolonged
remissions . For reasons that are not clear, some “experts” still question the
reversibility of NPH — and even its very existence.
The article is about the apparent lack
of awareness amongst today's doctors although neurologists thankfully are more
aware of it.
The article concludes:
Furthermore, other disorders of elderly people such as
Alzheimer’s disease, Parkinson’s disease, and cerebral atrophy may show
enlarged ventricles, and demential disorders may be difficult to differentiate
from each other. As a patient with NPH who had erroneously been thought by a
competent neurologist to have one of these other disorders for almost a decade
[14], I know this differential diagnosis is very difficult.
Moreover, the criteria to define cerebral
ventriculomegaly precisely are vague and difficult to establish, and enlarged
ventricles are surprisingly common. Many neuroradiologists are reluctant to
report borderline or even moderate degrees of hydrocephalus because such
diagnoses raise complex, medical, and socioeconomic issues and inadvertently
may lead to the performance of brain surgery in less than optimal surgical
candidates. Although shunt insertion is not complex surgery and has low
morbidity and mortality, it is not free of risk.
Finally, we believe strongly that elderly patients
with these symptoms and their loved ones should have the right to make an
informed decision as to whether they want shunt surgery, whatever the risk. The
first author, having experienced end-stage NPH and having been essentially
abandoned to his fate, did not feel that there was much to lose by choosing
surgery. Happily, his dementia was subtle and his value center intact, which
made the decision easy for him. Even though the decision may be more difficult
for naive patients, they should be given the opportunity to make it after an
unbiased presentation of the risks and benefits.
So please Mr Hunt and Mr Stevens, can we
get the doctors to think NPH before Dementia!
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