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, small 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 progress from urgency to frequency and eventually to complete incontinence as the condition worsens. Cognitive impairment in NPH presents as slowed thinking, apathy, forgetfulness, and difficulty with complex tasks, but is generally milder than in Alzheimer's disease and may appear as a subcortical dementia. These symptoms occur 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. Some studies also suggest that psychiatric symptoms, such as anxiety and depression, may be present in a significant proportion of patients with NPH 2. The symptoms of NPH are potentially reversible with treatment, typically through surgical placement of a ventriculoperitoneal shunt to drain excess fluid. Early recognition of this symptom triad is crucial, as treatment outcomes are better when intervention occurs before symptoms become severe or longstanding, as highlighted in a recent review 3.
Key Symptoms of NPH
- Gait disturbance
- Urinary incontinence
- Cognitive decline
- Psychiatric symptoms (in some cases)
Importance of Early Recognition
Early recognition of the symptom triad is essential for improving treatment outcomes, as delayed intervention can lead to severe and longstanding symptoms. A combination of clinical presentation, neuroimaging, and cerebrospinal fluid tests can aid in the diagnosis of NPH, as discussed in a recent study 1. The pathophysiology of NPH is not well described, and there is a significant overlap with degenerative and small vessel brain diseases, making selection of patients for surgery challenging 3. However, with proper evaluation and treatment, many patients with NPH can experience significant improvement in their symptoms, as reported in a study on the differential diagnosis and treatment of NPH 4.