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Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalus (NPH) typically affects people between the ages of 60 and 70 and happens when cerebrospinal fluid accumulates in excess within the ventricles of the brain. And, despite the excess fluid, the term includes the words “normal pressure” because, in a spinal tap, the cerebrospinal fluid pressure often registers as “normal.” Because NPH has symptoms that overlap with multiple forms of dementia, medical professionals can’t be certain how many people suffer from the brain disorder.



NPH is a gradually progressive disorder that is caused by a build-up of cerebrospinal fluid. NPH is often associated with an abnormal gait, incontinence, and dementia.



It’s known that our brains age and change along with the rest of our body – meaning memory slips and occasional confusion are not necessarily anything to be overly concerned about – but frequent expression of certain symptoms should lead to a conversation with the family doctor.

NPH typically presents with the following three symptoms:

  • Shuffling (this is often the first symptom that concerns close family and friends)
  • Urinary incontinence
  • Memory loss (also recognized as forgetfulness or lack of attention span)


Brain or Physical Changes

With NPH, the brain ventricles grow (as a result of the excess fluid) and can damage or disrupt brain tissue, eventually resulting in the symptoms associated with NPH.


Causes and/or Risk Factors

Most cases of NPH are considered idiopathic, meaning no known cause exists. In rare cases, NPH may develop as a result of head injury, brain surgery, tumor/cysts, bleeding during surgery, or subarachnoid hemorrhage.


Diagnosis, Treatment, and Care

Multiple clinical tests are used to evaluate the potential presence of NPH. Imaging studies, specifically, are critical in diagnosing NPH. Patients for whom NPH is suspected should undergo cerebrospinal fluid (CSF) removal, which provides both prognostic and diagnostic value. CSF removal requires an outpatient procedure and can go a long way in assessing the situation and creating potential solutions.

Note: Large-volume drainage that results in improved symptoms indicates a likely diagnosis of NPH.

Tests for NPH will likely include an interview, a physical, and a neurological exam. Specifically, during the physical exam, the medical professional may:

  • Ask questions about the patient’s walking
  • Observe the patient walking
  • Assess mental cognition by asking a series of questions
  • Assess attention, emotional state, language skills, reactionary time, and reasoning
  • Discuss urinary habits (including frequency, urgency, and the presence of incontinence)