However, behind this combination there may be normal pressure hydrocephalus (NPH), a neurological condition that often remains undiagnosed despite being treatable.

What Is Normal Pressure Hydrocephalus?

NPH is a special form of hydrocephalus that mainly affects older adults. Too much of the fluid that protects the brain slowly builds up. This makes the spaces inside the brain grow larger and can press on the brain.

This can trigger the typical symptoms: unstable gait, memory problems, and urinary incontinence.

Normal pressure hydrocephalus is frequently overlooked, but early diagnosis is important because NPH is treatable.

Which Symptoms Indicate Normal Pressure Hydrocephalus?

Three main symptoms are considered typical for normal pressure hydrocephalus. They usually develop gradually and are therefore often overlooked or attributed to aging:

• Gait disturbances are often among the first signs. Patients and their relatives often describe it as if the feet were stuck to the floor. Walking may appear wide-based, unstable, or shuffling.
• Cognitive changes may also occur. In many cases, dementia or Alzheimer’s disease is initially suspected.
• The third symptom is urinary incontinence.

Not all three symptoms necessarily appear at the same time. That’s why early diagnosis is so challenging.

Why Is NPH So Often Overlooked?

Even in everyday medical practice, normal pressure hydrocephalus is less well known than many other neurological disorders. General practitioners, caregivers, or nursing staff mainly encounter older patients with gait instability or cognitive decline and may initially diagnose dementia or Parkinson’s disease.

Relatives notice changes in behavior or mobility but are unsure whether these are normal signs of aging or symptoms of a disease. Yet this is crucial: the earlier NPH is identified, the greater the chances of significantly improving symptoms.

According to studies, approximately 3.7 % of people over the age of 65 and around 9 % of those over 80 are affected. Nevertheless, NPH remains significantly underdiagnosed. Every missed diagnosis means a lost opportunity for treatment and a reduced quality of life.

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How Is Normal Pressure Hydrocephalus Diagnosed?

If normal pressure hydrocephalus is suspected, several diagnostic steps follow. MRI or CT scans can show whether the brain’s ventricles are enlarged. This is an important indication of NPH.

In addition, a so-called spinal tap test is often performed. During this test, doctors remove a small amount of brain fluid from the spinal canal. If gait or cognitive function improves temporarily afterward, this is considered a strong indication of normal pressure hydrocephalus and of a likely positive treatment outcome.

How Is Normal Pressure Hydrocephalus Treated?

Although there is no cure to normal pressure hydrocephalus, treatment can significantly relieve symptoms. The most important therapy is the implantation of a shunt system. This is a small implanted system that drains excess brain fluid. The fluid flows into another part of the body, usually the abdominal cavity, where it can be absorbed naturally. The valve regulates the drainage of cerebrospinal fluid. Modern systems often use mechanisms that adjust pressure depending on body position and function with the gravitational technology.

This gravitational technology plays a crucial role in the cooperation between Neurosurgery and the MedTech Industry. Companies such as MIETHKE combine their expertise to develop solutions for hydrocephalus patients. The shared vision of MIETHKE and B. Braun is to improve the quality of life of people with hydrocephalus worldwide.

„Normal Pressure Hydrocephalus (NPH) is a common – and most often overlooked – condition affecting older adults. Too often, its symptoms are mistaken for just getting older, leaving many people untreated. Yet NPH is one of the very few neurological conditions of aging that can be effectively treated, with many patients regaining walking, cognition, and independence through a safe, cost-effective procedure“, says Mr Ahmed Toma.

Can Early Treatment Really Make a Difference?

Many studies show that timely treatment can significantly influence the life of patients. Gait disturbances in particular often respond well to shunt implantation. Cognitive abilities may also stabilize or improve. For patients, this often means regaining an important part of their quality of life. However, early diagnosis remains crucial. If NPH remains untreated for years, neurological damage may worsen.

Learn More

Normal pressure hydrocephalus often remains undetected for a long time. However, modern diagnostics, specialized neurosurgery, and innovative shunt technologies now offer real opportunities for noticeable improvements in quality of life.

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