Normal Pressure Hydrocephalus (NPH): Symptoms, Diagnosis & Treatment

Why NPH is Gaining Attention

In recent years, Normal Pressure Hydrocephalus (NPH) has become a widely searched health topic, particularly among aging populations. This growing interest can be attributed to the increasing awareness of neurodegenerative diseases and the advancement in diagnostic techniques. Often mistaken for Alzheimer’s disease or Parkinson’s disease, NPH is a treatable form of dementia that affects older adults, yet it remains underdiagnosed. According to the Hydrocephalus Association, an estimated 700,000 Americans may have NPH, but less than 20% receive an accurate diagnosis.

What is Normal Pressure Hydrocephalus?

Normal Pressure Hydrocephalus is a brain disorder characterized by the accumulation of cerebrospinal fluid (CSF) in the brain’s ventricles, causing them to enlarge and place pressure on nearby brain tissues. Despite the buildup of fluid, the pressure inside the ventricles remains within a normal range, which is why the condition is named as such.

Unlike other types of hydrocephalus, which often affect infants or young children, NPH typically occurs in adults over 60 years of age. This makes early recognition crucial for improving quality of life.

Symptoms of NPH

NPH is often called the “treatable dementia” because its symptoms mimic those of other neurodegenerative conditions. The hallmark symptoms are known as the classic triad:

• Gait disturbance: Often the first and most noticeable symptom. Patients walk with a wide base, shuffle, and may have difficulty initiating walking.
• Dementia or cognitive decline: Memory loss, slowed thinking, and difficulty concentrating are common.
• Urinary incontinence: Often appears later and may be misattributed to aging or other conditions.

These symptoms often develop slowly, leading to misdiagnosis as normal aging, Alzheimer's, or Parkinson’s disease. According to Dr. Michael Williams, a neurologist at the University of Washington Medical Center, the key to recognizing NPH is understanding that the symptoms appear together, not in isolation.

Causes and Risk Factors

The exact cause of NPH is often unknown, making it idiopathic. However, secondary NPH can occur after:

• Head trauma
• Brain surgery
• Infections such as meningitis
• Brain hemorrhages

Age is the biggest risk factor, and NPH is rarely seen in individuals under 60. Genetics may play a role, but more research is needed in this area.

Diagnosis of Normal Pressure Hydrocephalus

Diagnosis is challenging due to symptom overlap with other conditions. A combination of neurological evaluations and imaging studies is required, including:

• MRI or CT scans to detect enlarged ventricles
• Gait analysis and cognitive testing
• CSF tap test where a small amount of fluid is removed to assess symptom improvement
• Intracranial pressure monitoring in some cases

Accurate diagnosis is essential. According to a study published in the Journal of Neurology, Neurosurgery & Psychiatry, early diagnosis and treatment of NPH significantly improves outcomes.

Treatment Options

The most effective treatment for NPH is surgical intervention using a ventriculoperitoneal (VP) shunt. This device diverts excess fluid from the brain to the abdominal cavity, where it is absorbed.

Other treatment options include:

• Endoscopic third ventriculostomy (ETV) – less common but sometimes used
• Physical therapy for gait improvement
• Occupational therapy and cognitive rehabilitation

Outcomes vary, but according to Dr. Mark Hamilton of the University of Calgary, about 60-80% of patients experience significant symptom relief after shunt placement.

Prognosis and Long-Term Management

Prognosis depends on the patient’s age, overall health, and how quickly the diagnosis is made. Shunt surgery often halts or reverses symptom progression. However, regular follow-ups are essential to monitor shunt function and prevent complications like infection or blockage.

In some cases, shunt revisions may be required. Long-term management includes coordination with neurologists, neurosurgeons, and rehabilitation specialists.

NPH vs Alzheimer’s and Parkinson’s Disease

Because of symptom similarities, NPH is often misdiagnosed. The table below highlights the key differences:

Condition	Primary Symptoms	Treatable?
Normal Pressure Hydrocephalus	Gait disturbance, dementia, urinary incontinence	Yes (Shunt surgery)
Alzheimer’s Disease	Memory loss, disorientation	No (Manageable)
Parkinson’s Disease	Tremors, rigidity, slowed movements	No (Manageable)

Current Research and Future Directions

Recent research is focused on refining diagnostic criteria, improving imaging techniques, and developing less invasive surgical treatments. A 2022 study in Frontiers in Neurology explored biomarkers in CSF to distinguish NPH from Alzheimer’s more accurately.

Artificial intelligence (AI) and machine learning are also being integrated into MRI analysis to detect NPH earlier and more precisely.

Normal Pressure Hydrocephalus is a serious yet treatable condition that often masquerades as other neurodegenerative disorders. Increased awareness, early diagnosis, and appropriate treatment—especially with shunt surgery—can significantly improve a patient’s quality of life. If you or a loved one is experiencing symptoms consistent with NPH, consult a neurologist or neurosurgeon experienced in hydrocephalus management.

Raising awareness can help more people benefit from early intervention. Share this article to inform others about this often overlooked condition.