title: Cognitive Decline in Patients with Chronic Hydrocephalus and Normal Aging: 'Growing into Deficits'.
abstract: OBJECTIVE
  To explore the theory of 'growing into deficits', a concept known from developmental neurology, in a series of cases with chronic hydrocephalus (CH).
  
  
  METHODS
  Patients were selected from the Amsterdam Dementia Cohort and underwent extensive dementia screening.
  
  
  RESULTS
  Twelve patients with CH were selected, in whom Alzheimer's disease was considered unlikely, based on biomarker information and follow-up. Mean Mini-Mental State Examination score was 24 (range 7-30). Most patients were functioning on a level of mild dementia [Clinical Dementia Rating score of 0.5 in 8/11 (66.7%) patients]. On neuropsychological examination, memory and executive functions, as well as processing speed were most frequently impaired.
  
  
  CONCLUSIONS
  In our opinion, the theory of 'growing into deficits' shows a parallel with the clinical course of CH and normal aging when Alzheimer's disease was considered very unlikely, because most of these patients were functioning well for a very large part of their lives. The altered cerebrospinal fluid dynamics might make the brain more vulnerable to aging-related changes, leading to a faster cognitive decline in CH patients compared to healthy subjects, especially in case of concomitant brain damage such as traumatic brain injury or meningitis.
authors.affiliation: Department of Neurology and Alzheimer Center, VU University Medical Center and Neuroscience Campus Amsterdam, Amsterdam, The Netherlands; HagaZiekenhuis (Haga Hospital), The Hague, The Netherlands.
authors.forename: Marlijn H
authors.initials: MH
authors.lastname: de Beer
authors.affiliation: Department of Neurology and Alzheimer Center, VU University Medical Center and Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
keywords: Alzheimer's disease; Cerebrospinal fluid; Dementia; Hydrocephalus