From the Guidelines
Normal pressure hydrocephalus (NPH) is characterized by a classic triad of symptoms: gait disturbance, urinary incontinence, and cognitive decline, as noted in a recent study published in the Journal of Neuroinflammation 1. The symptoms of NPH can be understood by considering the effects of ventricular enlargement on surrounding brain tissue.
- Gait problems are typically the first symptom to appear, characterized by a slow, shuffling, wide-based "magnetic" gait where feet seem stuck to the floor.
- Urinary symptoms include urgency, frequency, and eventual incontinence due to frontal lobe dysfunction affecting bladder control, as seen in other conditions with localized inflammatory response 1.
- Cognitive impairment manifests as slowed thinking, apathy, forgetfulness, and difficulty with complex tasks, though it's usually milder than in Alzheimer's disease. Additional symptoms may include headaches, dizziness, falls, and depression, which can be related to the increased intracranial pressure and subsequent brain tissue compression. These symptoms develop gradually over months to years and result from ventricular enlargement causing compression of surrounding brain tissue, despite normal cerebrospinal fluid pressure, as described in the context of neuroinflammation and disease pathogenesis 1. The condition primarily affects adults over 60 and is potentially reversible with proper diagnosis and treatment, typically through surgical placement of a ventriculoperitoneal shunt to drain excess cerebrospinal fluid, highlighting the importance of early detection and intervention to improve patient outcomes.
From the Research
Signs and Symptoms of NPH
The signs and symptoms of Normal Pressure Hydrocephalus (NPH) can be summarized as follows:
- Gait ataxia, dementia, and urinary incontinence, also known as the Adams triad or Hakim's triad, are the typical symptoms of NPH 2, 3, 4, 5
- Gait ataxia is considered the guiding sign of NPH 2
- Dementia is a common symptom, but it is not significantly different from cerebral atrophy 2
- Urinary incontinence is often characterized as a symptom of late-stage NPH 2, 3
- Cognitive decline is also a common symptom of NPH 4, 6
Diagnosis and Staging
- The diagnosis of NPH can be confirmed using an intrathecal infusion test or a ventriculoperitoneal shunt 2, 5
- Subdivision of NPH into an early stage and a late stage can help with prognostic evaluations about the course of the disease 2
- Patients with early-stage NPH are more likely to report improvement of their symptoms after shunt operation than those with late-stage NPH 2
Treatment and Outcomes
- Ventriculo-peritoneal shunt (VPS) and lumbo-peritoneal shunt (LPS) are both effective treatments for NPH, but VPS provides faster symptom relief while LPS has a safer profile 4
- The choice of intervention should be tailored to the individual patient's risk profile, resource availability, and surgical expertise 4