Home > Diagnosis, Types of dementia > What Is Normal Pressure Hydrocephalus?

What Is Normal Pressure Hydrocephalus?

Normal pressure hydrocephalus is a progressive disorder that occurs in approximately 0.5% of adults over the age of 65.  Many persons with NPH are misdiagnosed as having Alzheimer’s disease or Parkinson’s disease, due to the similarity in symptoms.  However, unlike Alzheimer’s and Parkinson’s, NPH can often be at least partially reversed with proper and early treatment.

Hydrocephalus is a condition in which there is too much cerebrospinal fluid in the brain and spinal cord, particularly in cavities called ventricles.  CSF is the fluid that moves around the brain, acting as a shock absorber, providing nutrients, and removing some waste products.  Excess fluid usually drains away from the brain and is absorbed by other bodily tissues.  However, occasionally CSF doesn’t drain off and accumulates.  Because the skull doesn’t allow the brain to expand outward, the fluid presses on different parts of the brain, causing various symptoms depending on what parts of the brain are involved.  There are numerous possible causes of hydrocephalus, and can occur at any age.

Most types of hydrocephalus develop rapidly, often over a few hours’ time.  The sub-type known as NPH, however, is characterized by a gradual build-up of CSF.  The pressure it creates in the brain may not be as high, and the resulting symptoms may not be as noticeable, at least in the early stages.  It can occur after a head injury, a stroke, meningitis, a brain tumor, or surgery on the brain.  Often, however, the exact cause for the condition is never known.

There are two kinds of NPH:  idiopathic and secondary.  The idiopathic form of the disease has no identifiable cause, whereas the secondary form is usually due to some other condition such as an injury or infection.

Symptoms of NPH can include any or all of the following:

  1.  Memory loss
  2. Speech problems
  3. Apathy (indifference) and withdrawal
  4. Changes in behavior or mood
  5. Impaired reasoning, attention, or judgment
  6. Walking problems
  7. Unsteadiness
  8. Leg weakness
  9. Sudden falls
  10. Shuffling steps
  11. Difficulty initiating movement, or getting “stuck”
  12. Incontinent of urine
  13. Incontinent of feces (less common)
  14. Frequent urination
  15. Urgency to urinate
  16. Headache
  17. Nausea
  18. Difficulty focusing eyes

NPH can be difficult to differentiate from Alzheimer’s or Parkinson’s, without the use of brain imaging and an analysis of the patient’s cerebrospinal fluid.  The presence of the distinctive triad of cognitive, motor, and urinary symptoms should trigger a diagnostic work-up for possible NPH.  (Some refer to this syndrome as “wet, wobbly, and wacky.”)  It’s very important that this distinction is made, because the treatment for the three disorders is very different.  Evaluation generally consists of a comprehensive medical history, a detailed physical exam (including a neurological work-up), a mental status exam, and possibly neuropsychological testing.  While there are no lab tests that can diagnose the presence of NPH, others may be done in order to rule out other causes for the patient’s symptoms.  Brain imaging will be done, as well as a spinal tap.

As a rule, NPH cannot be cured.  With surgery, however, some individuals with the disease can see differing amounts of improvement in their symptoms.  If surgery is not possible, treatment usually consists of attempting to alleviate the symptoms of the disease, and to maximize functioning and quality of life.  There is a great variation in the amount of care that will be required by persons with NPH, depending on the severity of the disease.

Research is currently on-going in an effort to determine ways of preventing the development of NPH, to better understand the process and how it produces the symptoms characteristic of the disease, and to continue to improve the benefits from surgical and other forms of treatment.

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