In early October, American singer Billy Joel, 77, announced that he underwent brain surgery to treat an unusual and reversible form of dementia. The diagnosed condition was Normal Pressure Hydrocephalus (NPH), whose signs are often confused with other cognitive losses, such as Alzheimer's, but which has the characteristic of being curable if identified and treated at the appropriate time.
NPH is more prevalent in individuals over 60 years old, affecting, on average, one in every hundred people in this age group. It arises due to the abnormal accumulation of cerebrospinal fluid, the fluid that protects and nourishes the brain, specifically in the areas that produce this fluid. Symptoms manifest gradually, only when this fluid begins to exert pressure on the neurons. Prolonging the condition without treatment worsens brain damage, resulting in more frequent symptoms and decreasing the chance of full recovery.
Symptoms and Diagnosis
According to neurologist Iron Dangoni Filho, from Einstein Israelite Hospital in Goiânia, primary signs include changes in gait, characterized by a more robotic walk, occurrence of urinary incontinence or urgent need to urinate, in addition to slower mental processing. It is important to note that not all patients exhibit all these symptoms simultaneously.
The ambiguous nature of NPH signs contributes significantly to delayed diagnosis. Dangoni warns that family members often associate the symptoms with the natural aging process. Additionally, when there is an intention to seek medical help, patients tend to consult other specialists, such as urologists and orthopedists, wasting valuable time that could optimize the response to treatment.
The diagnosis of NPH is established by observing clinical indicators and confirmed through an MRI scan, which helps detect changes in the ventricles filled with cerebrospinal fluid. If the diagnosis is early, surgery is performed that can reverse the disease and achieve a complete cure. This procedure involves implanting a valve that diverts excess fluid into the abdominal cavity, where it will be reabsorbed by the body.
Surgical Evaluation and Tap Test
However, the surgical procedure presents complexities, especially in elderly patients, and is not indicated for everyone. International guidelines suggest that only about six to eight out of ten people with the disease will benefit from symptom reversal through surgery. This occurs because prolonged coexistence with NPH causes deterioration in the neural structures themselves, and this recovery is not possible even with pressure reduction.
To assess potential benefits, there is an examination called the Tap test. This technique allows for temporary relief of pressure by draining cerebrospinal fluid via lumbar puncture, making it a much less invasive method than surgery. After collection, it is checked whether there has been an improvement in gait and urinary control. The test can be repeated up to 48 hours after the first puncture to assess the effectiveness of proceeding to definitive treatment.
Although the Tap test is available in private centers in Brazil, it is not part of the mandatory list of exams covered by health insurance plans or the Unified Health System (SUS). However, some public health services perform a subjective analysis, where punctures are made, but evaluations depend on the patient's report.
The doctor at Einstein in Goiânia commented that a positive result on the Tap test offers greater security for performing surgery, as it proves the benefits. For healthcare professionals, receiving a positive test and conducting a successful surgery is a source of satisfaction. In Goiânia, the exam is available completely, using a set of sensors called baiobit, which makes the evaluation more precise and objective, standardizing measurement and allowing for the observation of subtle improvements.
Iron Dangoni added that in neurological practice, they deal with various progressive dementias, which are at best controllable. He finds it extremely gratifying to see a patient who had mobility difficulties moving freely and recovering their own memories.
In Billy Joel's specific case, the surgery was performed, allowing for the reversal of symptoms. In his weekly radio show, he reported noticing improvements in memory and balance shortly after the procedure, without returning to NPH symptoms. The neurologist concluded that knowing cases of famous personalities helps raise awareness about the disease, which can save lives, reinforcing that the earlier the diagnosis is made, the higher the chances of post-surgical therapeutic success.
