From the Research
Normal pressure hydrocephalus (NPH) is characterized by a classic triad of symptoms: gait disturbance, urinary incontinence, and cognitive decline, as well as psychiatric symptoms such as anxiety, depression, and psychotic syndromes, which are present in approximately 71% of patients 1. The symptoms of NPH can be broken down into the following categories:
- Gait disturbance: 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 incontinence: begins with urgency and frequency, eventually progressing to complete incontinence as the condition worsens
- Cognitive decline: presents as slowed thinking, apathy, forgetfulness, and difficulty with complex tasks, but is usually milder than in Alzheimer's disease
- Psychiatric symptoms: anxiety, depression, psychotic syndromes, obsessive compulsive disorder, and personality changes, which can be present in up to 71% of patients 1 These symptoms develop gradually due to an accumulation of cerebrospinal fluid in the brain's ventricles, which puts pressure on surrounding brain tissue despite normal cerebrospinal fluid pressure readings during lumbar puncture. The condition primarily affects adults over 60 years old and is potentially reversible with proper treatment, typically through surgical placement of a shunt to drain excess fluid, as supported by the most recent study in 2020 2. Early recognition of this symptom triad is crucial, as treatment outcomes are better when intervention occurs before symptoms become severe. It is essential to note that NPH can be misdiagnosed, and a high index of suspicion is necessary to make an accurate diagnosis, especially in patients presenting with atypical symptoms or psychiatric disorders 1, 2.