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Normal pressure hydrocephalus (NPH) is a neurological disorder that causes dementia. It’s characterized by walking abnormalities, dementia, and impaired bladder control.
NPH is relatively rare. According to the Hydrocephalus Association, an estimated 700,000 Americans suffer from the disorder. NHP is difficult to diagnose because its symptoms resemble other neurological diseases. Your doctor must consider your symptoms and run numerous tests to make the diagnosis. For this reason, many people go undiagnosed.
There are two types of NPH. The first type is idiopathic (iNPH). The cause of iNPH is unknown, but it most commonly occurs over the age of 60. It affects both men and women equally. The second type of NPH is known as secondary form. It’s caused by secondary disorders or symptoms that can occur at any age.
The only effective treatment for NPH is ventricular shunting. This is a surgical procedure used to relieve pressure in your brain. Most people show significant improvement after shunt placement. In fact, NPH is one of only a few causes of dementia that is potentially reversible.
The risk of developing NPH increases after the age of 60. As you grow older, you may have more risk factors. Risk factors of NPH include:
The exact cause of idiopathic NPH is still unknown. However, some studies have theorized that iNPH is related to:
Secondary form NPH is precipitated by another physiologic or disease process.
Conditions that may cause this type of NPH include:
The three symptoms that characterize NPH are walking abnormalities, dementia, and impaired bladder control.
Minor symptoms in early NPH include:
Over time these symptoms will become more noticeable.
Examples of walking abnormalities include:
Bladder symptoms caused by NPH include:
Dementia symptoms include:
It can be hard to diagnose NPH because it appears similar to other neurodegenerative diseases. Multiple tests must be used to gather sufficient evidence for a diagnosis of NPH.
Neurodegenerative diseases with symptoms similar to NPH include:
To help rule out other neurological conditions, your doctor will test your mental function. This will include a mini-mental state examination, which tests your cognitive function. Your doctor may also use other assessments to test your attention and executive function, including:
Imaging tests of the brain are helpful, though insufficient for a diagnosis. Examples of these include:
Invasive diagnostic tests help to confirm the diagnosis of NPH. These tests include:
The only successful treatment for NPH is ventricular shunting. A ventricular shunt is a medical device implanted in your brain that relieves pressure caused by fluid accumulation. Ventricular shunts are surgically implanted to drain excess CSF, which in turn relieves pressure.
Three types of shunts are used:
The shunt will have valves to control the amount of CSF drainage. The options for valves include:
All surgery carries the risk of complications. Shunt surgery has serious risks that include:
In one study, of the patients who receive a shunt, 59 percent showed improvement. However, surgery isn’t an option for every patient with NPH. And those with severe dementia are discouraged as the risks of surgery outweigh the benefits. Also, many times people require more than one surgery to maintain improvement. Your doctor will weigh the risks and benefits of the procedure to determine the best course of action.
Your outlook will vary according to your age, previous health problems, and surgery. A healthy person who receives an early diagnosis has the best outlook. More than 70 percent of people who undergo modern treatment like ventriculoperitoneal shunting have clinical improvement.
Written by: Lydia Krause
Medically reviewed on: Mar 22, 2016: University of Illinois-Chicago, College of Medicine
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