Normal Pressure Hydrocephalus: A Lesser-Known Dementia

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Man-with-Cane-152x300.jpgAlthough many people are familiar with Alzheimer’s and vascular dementia, there are actually numerous other forms of dementia which are not as well-known. One of these is called normal pressure hydrocephalus, or NPH.

What is NPH?

Normal pressure hydrocephalus is a specific form of the more general condition hydrocephalus. Hydrocephalus comes from two Greek words, meaning “water” and “head.” In hydrocephalus, an excess of cerebrospinal fluid builds up in the brain. Cerebrospinal fluid is needed to keep the brain functioning properly, but when there is too much of it, the ventricles in the brain increase and pressure develops in the brain.

NPH occurs most often in older adults. It differs from regular hydrocephalus in that, while there is an increase in cerebrospinal fluid, there is less consistent increase in pressure.

The Hydrocephalus Association estimates that 700,000 American have NPH, but fewer than 20% of them have been properly diagnosed. More often, NPH is misdiagnosed as Alzheimer’s disease or as Parkinson’s. Proper diagnosis is important, because unlike many other forms of dementia, NPH can sometimes be reversed if it is diagnosed and treated early.


There are three main symptoms typically associated with NPH (although not all sufferers of NPH will exhibit all symptoms). They are:

Difficulty walking, which may range from feeling unbalanced to a noticeable change in a person’s gait to an inability to walk, period. This is usually the first symptom to show up.

Bladder issues, which can range from full-blown incontinence to an increase in frequency and urgency.

Mild dementia, not as severe as fully progressed Alzheimer’s, but marked by  forgetfulness, impaired short-term memory, etc.

Most often, NPH is treated by surgically inserting a shunt into the ventricles of the brain. The shunt is a tube, and it takes the excess cerebrospinal fluid from the brain and redirects it elsewhere. In rare cases, a procedure called endoscopic third ventriculostomy (ETV) may be suggested. This is usually done when a person has a condition which prevents the use of a shunt.

More than 80% of patients who receive shunt treatments see a significant improvement, with some seeing a reversal of dementia as a result.

Individuals who think their loved one’s dementia may be due to NPH should consult with an experienced doctor (such as a neurologist or a neurosurgeon) to achieve a diagnosis.


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