@shanehall I'm sorry, as I know this is very difficult for the family when someone changes. This isn't a difficult surgery to get a shunt, and it isn't uncommon. It sounds like her providers are avoiding it. She may need another opinion from a neurologist who works with problems in elderly patients. I'm glad you reached out here. In my father in law's case, he was an Alzheimers patient in a nursing home, and the nursing home suggested the surgery because he was aggressive and combative. It may have helped a little, but the Alzheimers may have been causing the aggression too.