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When an older adult begins walking more slowly, struggles to maintain balance, or experiences changes in memory, these symptoms are often attributed to ageing. In some cases, they may be associated with conditions such as dementia or Parkinson’s disease.
However, when memory changes occur alongside difficulty walking and bladder control problems, another neurological condition may need to be considered: Normal Pressure Hydrocephalus (NPH).
Normal pressure hydrocephalus is a condition involving the accumulation of cerebrospinal fluid (CSF) within the brain’s fluid-filled spaces, called ventricles. This can affect walking, thinking and bladder function. Importantly, NPH is one of the conditions that may be treatable, making early recognition and accurate diagnosis particularly important.
At the Citi Neuro Centre, neurological evaluation can help investigate changes in memory, mobility and coordination and determine whether they may be associated with an underlying brain condition.
Understanding the symptoms of NPH can help families recognise when these changes deserve more than routine observation.
Normal Pressure Hydrocephalus (NPH) is a neurological condition in which cerebrospinal fluid accumulates within the brain’s ventricles, causing them to enlarge.
Cerebrospinal fluid normally circulates around the brain and spinal cord, providing cushioning and supporting the nervous system. When its circulation or absorption becomes impaired, fluid can accumulate and affect the surrounding brain structures.
In NPH, the pressure measured within the brain may not be consistently elevated, despite the enlarged ventricles and associated neurological symptoms.
The condition is most commonly recognised in older adults and can cause changes in walking, bladder control, memory and thinking.
Unlike many progressive conditions that cause dementia-like symptoms, NPH may improve with appropriate treatment in selected patients. However, not everyone with these symptoms has NPH, and a specialist assessment is necessary to establish the diagnosis.
NPH is associated with an abnormal accumulation of cerebrospinal fluid within the brain’s ventricles.
It is generally classified into two forms:
In idiopathic NPH, the underlying cause is not clearly identified. It is more commonly recognised in older adults and may develop gradually without an obvious preceding neurological event.
Secondary NPH can develop following an identifiable event or condition that affects cerebrospinal fluid circulation or absorption.
Possible causes include:
Identifying whether NPH is idiopathic or secondary can help specialists understand the clinical context and plan further evaluation.
NPH is classically associated with three main symptoms: gait disturbance, cognitive changes and urinary symptoms. These symptoms may develop gradually and do not necessarily appear together.
Changes in walking are often among the earliest and most noticeable features of NPH.
A person may experience:
This pattern can sometimes resemble Parkinson’s disease or other movement disorders.
However, walking difficulties have many possible causes, including joint problems, peripheral nerve disorders, spinal conditions and other neurological diseases. A detailed neurological and gait assessment helps determine which possibilities need further investigation.
NPH can affect more than physical movement. It may also influence how a person processes information, concentrates and performs everyday activities.
Possible changes include:
These symptoms may resemble dementia or age-related cognitive decline.
However, memory problems should not automatically be attributed to ageing. A neurological assessment can help distinguish NPH from Alzheimer’s disease, vascular cognitive impairment, medication-related problems and other potentially treatable causes of cognitive changes.
Urinary symptoms may develop as the condition progresses.
A person may experience:
These symptoms can have several causes, including urinary tract conditions, prostate problems, medication effects and other neurological disorders.
When urinary symptoms occur alongside progressive walking difficulties and cognitive changes, NPH may be one of the conditions a neurologist considers.
Feature | Normal Pressure Hydrocephalus | Dementia | Parkinson’s Disease |
Walking | Short, shuffling steps; difficulty initiating movement | May become affected as the condition progresses | Slowness, stiffness, shuffling or freezing may occur |
Thinking and memory | Slowed thinking, attention and executive function may be affected | Cognitive decline is a central feature in many forms | Cognitive changes may occur, particularly as disease progresses |
Bladder symptoms | Urgency or incontinence may occur | May occur in some forms or later stages | Urinary symptoms may occur |
Assessment | Clinical examination, brain imaging and selected CSF tests | Cognitive assessment and investigations for underlying causes | Clinical movement assessment and evaluation for other causes |
Treatment approach | CSF diversion with a shunt may help selected patients | Depends on the underlying type and cause | Medication, rehabilitation and other treatments depending on symptoms |
These are general patterns, not diagnostic rules. Symptoms can overlap, and a person may have more than one condition at the same time.
When an older adult begins walking more slowly, struggles to maintain balance, or experiences changes in memory, these symptoms are
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Diagnosing NPH involves more than identifying memory loss or enlarged ventricles on a scan. Specialists consider the symptom pattern, neurological examination, imaging findings and, where appropriate, additional tests.
The neurologist reviews the person’s symptoms, medical history, medications and changes in everyday functioning.
The assessment may include:
Information from family members can be particularly useful because gradual changes may be easier for others to notice.
Brain MRI is particularly useful for evaluating the size and appearance of the brain’s ventricles and identifying other structural abnormalities.
A CT scan may also help assess ventricular enlargement when appropriate.
However, enlarged ventricles alone do not confirm NPH. Specialists interpret imaging alongside the patient’s symptoms and examination because ventricular enlargement can occur for other reasons.
In selected patients, a specialist may recommend a CSF tap test, which involves removing a measured amount of cerebrospinal fluid through a lumbar puncture.
Walking and other relevant symptoms may be assessed before and after the procedure to determine whether there is measurable improvement.
A positive response may support the possibility that the patient could benefit from a shunt procedure. However, a negative result does not necessarily exclude NPH, and further assessment may be needed.
Depending on the clinical findings, specialists may consider:
The choice of tests depends on the individual presentation and the findings from the initial evaluation.
Treatment depends on the diagnosis, symptom severity, overall health and likelihood of benefiting from intervention.
1. Shunt Surgery
For appropriately selected patients, the principal treatment for NPH is CSF shunt surgery.
A shunt is a medical device that diverts excess cerebrospinal fluid away from the brain’s ventricles, commonly into the abdominal cavity through a ventriculoperitoneal shunt.
The aim is to improve the effects of abnormal CSF accumulation and, where possible, improve symptoms.
Potential benefits vary between individuals. Walking difficulties may respond differently from cognitive or bladder symptoms, and improvement is not guaranteed. Shunt surgery also carries risks, including infection, bleeding, obstruction and excessive drainage.
2. Monitoring and Follow-Up
Patients undergoing evaluation or treatment require appropriate clinical follow-up.
For patients who receive a shunt, follow-up helps monitor symptom changes, assess treatment response and identify possible complications.
If symptoms return or new problems develop after surgery, prompt medical review is important.
3. Rehabilitation and Supportive Care
Rehabilitation may be recommended to address mobility, balance and functional limitations.
Depending on individual needs, supportive care may include:
Rehabilitation complements medical or surgical treatment; it does not replace the need to investigate the underlying cause of symptoms.
One of the major challenges with NPH is that its symptoms can resemble other conditions commonly seen in older adults.
Walking difficulties may be attributed to ageing or joint problems, while memory changes may be mistaken for dementia. When these symptoms are considered separately, the possibility of a shared neurological cause may be overlooked.
Recognising the combination of symptoms can help prompt a more targeted evaluation.
Early assessment may help specialists:
Early diagnosis does not guarantee recovery, but timely evaluation can help identify patients who may benefit from treatment.
Consider a neurological assessment if an older adult develops progressive changes such as:
These symptoms do not automatically indicate NPH, but they warrant appropriate medical evaluation.
Important: Sudden confusion, sudden weakness, new speech difficulties or an abrupt inability to walk should be treated as an emergency rather than assumed to be NPH. Seek immediate medical attention.
At Citi Neuro Centre, neurological assessment can help investigate complex symptoms involving memory, movement, coordination and other aspects of brain function.
For patients experiencing memory loss and walking difficulties, a specialist evaluation can help determine whether the symptoms may be associated with normal pressure hydrocephalus or another neurological condition.
Assessment may involve clinical examination, review of brain imaging and referral for additional investigations where appropriate. Treatment decisions depend on the diagnosis, the patient’s overall health and the potential benefits and risks of available options.
For individuals seeking a neurologist in Hyderabad, timely evaluation can help clarify unexplained neurological changes and guide appropriate care.
Normal Pressure Hydrocephalus (NPH) is an important condition to consider when memory changes occur alongside walking difficulties and bladder symptoms, particularly in older adults.
Although these symptoms can resemble dementia or Parkinson’s disease, NPH has a different underlying mechanism and may be treatable in selected patients.
Recognising the pattern, obtaining appropriate brain imaging and undergoing a specialist neurological assessment can help determine the cause and whether further treatment may be beneficial.
If you or a family member is experiencing progressive changes in walking, memory or bladder control, consult a neurologist rather than assuming these symptoms are simply part of ageing.
At Citi Neuro Centre, timely neurological evaluation can help guide the next steps towards an accurate diagnosis and appropriate care.
