By : Lamiaa Moustafa Elbosaty
Dementia due to Normal Pressure Hydrocephalus: Normal pressure hydrocephalus is referred to a miscellaneous disorder causing dementia in the older adult. It is an obstruction of the flow and absorption of cerebrospinal fluid that results in a normal cerebrospinal fluid high pressure. The ventricles enlarge, exerting a force that compresses cerebral tissue (Arciniegas & Dubovsky, 2001). The incidence has been estimated at 2.2 per million per year, and the prevalence has been estimated at 5.000 to 10.000 patients in United States. It typically occurs during the sixth or seventh decade of life, although it has been reported in children and young adults (Victor & Ropper, 2001).
Gait changes, dementia, and urinary incontinence are the classic clinical findings of this disorder. The gait changes usually occur first and are prominent finding. The cognitive changes are a rapid onset and are characterized as short-term memory loss, poor judgment, lack of initiation and disinhabitation. Urinary incontinence typically occurs last in the presentation of normal pressure hydrocephalus, with urgency and frequency preceding loss of sphincter control (Cammermeyer, 2001).
- Dementia due to Subdural Hematoma: A reversible cause of dementia in the older adult is chronic subdural hematoma. Older persons are predisposed to chronic subdural hematoma because of the increased stress on the cerebral veins with shrinkage of the brain away from the dura, the most common cause is trauma, representing about 75% of cases in the older adult (Rao & Lykestos, 2002). Cognitive impairment is common after head trauma, although the severity and duration of the deficits are related to the extent and location of damage, duration of post traumatic amnesia,
brain stem dysfunction and degree of axonal injury (Rapoport & Feinstein, 2000).
Common symptoms of chronic subdural hematoma include headache, altered mental status, gait changes or ataxia, aphasia, and hemi paresis. The presentation of chronic subdural hematoma mimics other neurological diseases, including dementia, stroke, tumors, and normal pressure hydrophalus. Chronic subdural hematoma causes mental status changes that develop over the course of 2 to 6 weeks, may have focal neurological signs, and usually does not have urinary incontinence as an initial feature (Karnath, 2004).
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