Normal Pressure Hydrocephalus, NPH, is an important condition. Although uncommon, affecting less than 5% of the population, it is a TREATABLE form of DEMENTIA.

If you or a loved one has been suspected of having Alzheimers or Parkinsons disease, NPH should be considered. It can be ruled out by MRI. Problems with Walking (“ Gait”) is often the first symptom, followed by mild Dementia. Loss of urinary control, incontinence, is often a later symptom.

The classic 3 symptoms are gait problems, dementia and incontinence, Hakim’s triad. A politically incorrect MNEMONIC is “wet, wacky and wobbly”. Gait “deviations”, with a broad based, slow, “stuck to the floor” movement are present almost all the time, and often suggests the more common Parkinson’s disease.

Some difficulty in planning, attention and concentration is present more than half of the time. Frequency of urination and incontinence comes later, but is often present by the time the diagnosis is made. Block in the reabsorption of Cerebrospinal fluid is thought to be the cause.

This produces intermittent elevation of pressure in the brain cavities, the ventricles. Thinning of the cortex follows, and it is this loss of brain tissue that produces the symptoms the diagnosis, usually by a Neurologist, is made by a number of tests, including MRI, and measurements of CSF Pressure.

An interesting test is to remove 30-50 cc of CSF and see if the walking improves. Treatment is with a tube connecting the Ventricles to the abdominal cavity, which restores drainage of the CSF. One of my friends was diagnosed with NPH, and benefitted with treatment. I consulted a neurologist about another of my friends with dementia, and an MRI to rule out NPH was suggested.

Treatability is the main virtue of discovering NPH, rather than another cause of dementia.

–Dr. C.