From the Research
Normal pressure hydrocephalus (NPH) is characterized by a classic triad of symptoms: gait disturbance, urinary incontinence, and cognitive decline, as reported in the most recent study 1. The gait problems typically appear first and include shuffling, short steps, difficulty initiating walking, and a feeling of the feet being "stuck" to the floor, often described as a magnetic or parkinsonian gait. Urinary symptoms begin with urgency and frequency, eventually progressing to complete loss of bladder control. Cognitive impairment in NPH presents as slowed thinking, apathy, forgetfulness, and difficulty with complex tasks, but is generally milder than in Alzheimer's disease. These symptoms develop gradually as cerebrospinal fluid accumulates in the brain's ventricles, compressing surrounding brain tissue despite normal pressure readings during lumbar puncture. The condition primarily affects adults over 60 and is one of the few potentially reversible causes of dementia. Early recognition of this symptom triad is crucial because timely treatment with surgical placement of a shunt to drain excess fluid can significantly improve symptoms, particularly gait disturbance, which tends to respond best to intervention, as supported by 2. It's worth noting that psychiatric symptoms, such as anxiety and depression, may also be present in patients with NPH, as reported in 3, but the classic triad of symptoms remains the primary diagnostic criterion. Overall, the symptoms of NPH can be significantly improved with timely treatment, making early recognition and diagnosis critical 1.
Some key points to consider when diagnosing NPH include:
- The presence of the classic triad of symptoms: gait disturbance, urinary incontinence, and cognitive decline
- The use of neuroimaging and cerebrospinal fluid tests to support the diagnosis, as recommended in 2
- The potential for significant improvement in symptoms with timely treatment, particularly gait disturbance, as reported in 1 and 4
- The importance of early recognition and diagnosis to ensure the best possible outcomes for patients with NPH.