From the Research
Normal pressure hydrocephalus (NPH) is characterized by a classic triad of symptoms: gait disturbance, urinary incontinence, and cognitive decline, with the most recent and highest quality study suggesting that early identification and treatment can significantly improve quality of life 1. The symptoms of NPH can be summarized as follows:
- Gait disturbance, which typically appears first and includes 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, which progress from urgency to frequency and eventually to complete incontinence as the condition worsens
- Cognitive impairment, which presents as slowed thinking, apathy, forgetfulness, and difficulty with complex tasks, but is usually milder than in Alzheimer's disease Additional symptoms may include headaches, dizziness, falls, and depression. These symptoms occur because cerebrospinal fluid accumulates in the brain's ventricles, causing them to enlarge and compress surrounding brain tissue, despite normal cerebrospinal fluid pressure readings during lumbar puncture. The diagnosis of NPH is made based on suspicion of NPH symptoms, the additional finding of ventriculomegaly on imaging, and confirmatory testing with a trial of CSF drainage, which can predict improvement with CSF shunting 2. The best treatment outcomes typically occur in patients who primarily show gait disturbance rather than advanced cognitive decline, and early identification and treatment with surgical placement of a shunt to drain excess fluid can significantly improve quality of life 1.