'Normal'-pressure Hydrocephalus and the Saga of the Treatable Dementias

SELECTED CASE A 74-YEAR-OLD widow presented to the Laboratory of Neurosciences of the National Institute on Aging in February 1985 with a 4-year history of progressive cognitive impairment. She had experienced gradual onset of memory loss, with occasional urinary incontinence. There was no history of hypertension, cardiovascular disease, diabetes, head trauma, stroke, or intracranial bleeding or infection. She was not taking any medications. Social and family histories were not contributory.

Findings from a general physical examination were normal. Neurological examination disclosed a mild dementia, with impaired memory, calculations, and constructions. Her score on the Mini-Mental State Examination¹ was 22 (23 to 30 is normal), and her score on the Blessed Memory and Information Concentration Test was 22 (normal score is 37).² She had poor balance but normal gait. Results from routine laboratory tests of blood and urine were normal, as was an electroencephalogram. Cerebrospinal fluid protein level, glucose