“ASK THE DOCTOR” WITH REBECCA GILBERT
Q: How does a neurologist diagnose normal pressure hydrocephalus as opposed to Parkinson’s disease? My doctor is not sure which one I have.
A: Normal pressure hydrocephalus (NPH) is a condition that happens when cerebrospinal fluid builds up inside your skull and presses on your brain, and it is diagnosed based on the size of the ventricles on a brain MRI. (Ventricles are fluid-filled cavities within the brain). If they are too big, they can cause cognitive problems, urinary problems, and problems walking that can resemble the walking issues of someone with PD. However, the size of the ventricles exists on a spectrum — they can be just slightly enlarged or very big. If they are only a little enlarged, then the contribution of the size of the ventricles to any neurological issues may not be clear. To treat NPH, an indwelling shunt is placed into the ventricle to drain fluid. It is an invasive procedure with its own set of risks, so your doctors want to make sure that the potential benefits are worth the risks.
Datscan will be very helpful here. It should not be positive if there is only NPH as the cause of the walking difficulties.
Q: My father is 87 years old, has Parkinson’s disease, and has a lot of drooling/excess saliva. Are there ways to treat this?
A: Yes! There are lifestyle modifications such as chewing gum or sucking on a hard candy that may be helpful for certain people to stimulate more frequent swallowing. Speech and swallow therapy with a speech-language pathologist (SLP) trained in neurodegenerative conditions can be helpful, although gains are typically difficult to maintain.
Oral medications are available to decrease excess saliva. Unfortunately, they can also cause effects in other parts of the body such as urinary retention, constipation, blurry vision, and cognitive side effects, especially in older adults. Botulinum toxin injections into the salivary glands can decrease production of saliva and thereby decrease drooling. Botulinum toxin injections are generally well-tolerated, with effects typically lasting 2–4 months.
Learn more about oral dysfunction
Dr. Rebecca Gilbert is the Chief Mission Officer at APDA. She oversees APDA’s research portfolio in conjunction with APDA’s Scientific Advisory Board. She also provides medical and clinical expertise to support APDA programming as well as print and web content.