From the Guidelines
Normal pressure hydrocephalus (NPH) is characterized by a classic triad of symptoms: gait disturbance, urinary incontinence, and cognitive decline, as evidenced by recent guidelines 1. The symptoms of NPH can be broken down into:
- Gait problems, which typically appear first, with patients developing a slow, shuffling, wide-based "magnetic" gait
- Urinary symptoms, including urgency, frequency, and eventual incontinence
- Cognitive changes, manifesting as mild dementia, with slowed thinking, forgetfulness, apathy, and difficulty with complex tasks Additional symptoms may include headaches, dizziness, falls, and depression, which develop gradually over months or years and result from cerebrospinal fluid accumulating in the brain's ventricles, causing pressure on surrounding brain tissue despite normal pressure readings during lumbar puncture, as described in the ACR Appropriateness Criteria for dementia 1. The importance of identifying NPH lies in its potential reversibility with surgical shunting procedures, making it a crucial diagnosis to consider in adults over 60 presenting with these symptoms, and MRI findings, such as moderate ventriculomegaly and increased CSF flow void through the cerebral aqueduct, can help in identifying shunt-responsive NPH patients 1.
From the Research
Symptoms of Normal Pressure Hydrocephalus
The symptoms of normal pressure hydrocephalus (NPH) can be summarized as follows:
- Mental impairment or dementia 2, 3, 4, 5
- Gait disturbance, characterized by a hypokinetic gait disorder, shuffling, bradykinesia, and mild drifting 2, 3, 4, 5
- Urinary or fecal incontinence 2, 3, 4, 6, 5
Clinical Presentation
The clinical presentation of NPH can be variable, but the typical triad of symptoms includes:
- Gait disturbance as the cardinal sign of NPH 3
- Mild dementia 2, 3, 4
- Urinary urgency, frequency, nocturia, and incontinence 3
- Bladder and bowel incontinence 3
Importance of Early Diagnosis
Early diagnosis of NPH is crucial, as it can lead to a complete reversal of symptoms with early therapy 6. Accurate diagnosis and identification of responders to treatment are important to increase the rate of success to treatment 4.