NPH (Normal Pressure Hydrocephalus)

NPH is a form of hydrocephalus that generally affects older adults. As with other forms of hydrocephalus where too much CSF accumulates in the brain, serious damage and our ability to move, think and function normally can be significantly impacted. NPH sometimes occurs with little or no increase in intercranial pressure.

NPH is considered by some to be a potentially reversible form of dementia. Those affected generally suffer a triad of debilitating symptoms which include challenges with:

The greatest challenge in getting care for NPH is lack of awareness. Getting an early diagnosis and proper treatment can be difficult because the public and most family physicians are unaware of the condition.

Unfortunately, too many people with NPH are not being diagnosed or are misdiagnosed with diseases associated with aging, such as Alzheimer’s, dementia or Parkinson’s. A delayed diagnosis can be devastating and cause irreversible brain damage.

NPH affects more than 1 in 200 adults over the age of 65 – most of them are undiagnosed. This means thousands of people, who have much to live for, may be unnecessarily losing their independence, time with loved ones and admitted to long term care facilities prematurely. If you suspect someone you know may have NPH, be sure to ask about it specifically and insist the proper diagnostic testing be done.

Normal Pressure Hydrocephalus (NPH) Frequently Asked Questions

What is Normal Pressure Hydrocephalus (NPH)?

It is a condition where cerebrospinal fluid (CSF) – a clear fluid that acts as a protective cushion for our brain and spinal cord – accumulates to
an abnormal level within the brain, causing the symptoms of NPH. NPH affects more than 1 in 200 adults over the age of 65 – most of them are undiagnosed. This means thousands of people, who have much to live for, may be unnecessarily losing their independence, time with loved ones and admitted to long term care facilities prematurely. If you suspect someone you know may have NPH, be sure to ask about it specifically and insist that proper diagnostic testing be done.

How is NPH Diagnosed?

In most cases if NPH is suspected, your family doctor will refer you to a neurologist. The neurologist may do an exam that includes evaluation of how you walk, process information, speak and inquire about your bladder function. They may also order an MRI, CT scan or a lumbar puncture.

The symptoms of NPH are similar to Alzheimer’s and Parkinson’s diseases, however, the combination of dementia-like symptoms, altered walking (shuffling feet, short steps, a feeling like one’s feet are stuck to the floor) and urinary incontinence should alert your health care provider to consider NPH. If Normal Pressure Hydrocephalus is determined to be likely, then a referral to a neurosurgeon is the next step to discuss treatment options.

How is NPH Treated?

The most common treatment for NPH is the surgical placement of a shunt, a device that drains excess cerebral spinal fluid (CSF) from the brain to another part of the body. A shunt is a flexible piece of tubing that is attached to a valve that controls the flow of CSF.

Endoscopic third ventriculostomy (ETV) surgery is an alternative for some individuals to shunting. An ETV involves making an opening in the floor of the third ventricle at the base of the brain. The CSF can flow around the brain through the new pathway. An ETV can also fail or become blocked. Not everyone with hydrocephalus is a candidate for ETV surgery. A neurosurgeon will make the determination of the best course of treatment on a case-by-case basis.

The symptoms of NPH are similar to Alzheimer’s and Parkinson’s diseases, however, the combination of dementia-like symptoms, altered walking (shuffling feet, short steps, a feeling like one’s feet are stuck to the floor) and urinary incontinence should alert your health care provider to consider NPH. If Normal Pressure Hydrocephalus is determined to be likely, then a referral to a neurosurgeon is the next step to discuss treatment options.

What Kind of Lifestyle Can I Expect to Have Living with NPH?

The symptoms of abnormal gait, dementia and bladder control may improve within days of shunt surgery, or may take weeks to months to improve. Generally, individuals with a shunt are not restricted in their daily activities, except those involving great physical exertion. Most people can look forward to a normal future. But because hydrocephalus is an ongoing condition, follow-up and long-term care by a neurosurgeon or neurologist is sensible and encouraged. Especially if symptoms come back.

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Meet Maureen McIntyre and hear her journey with Normal Pressure Hydrocephalus (NPH)