Specific Types & Syndromes
Normal pressure hydrocephalus (NPH)
Normal pressure hydrocephalus is a form, mainly in older adults, with enlarged ventricles and a classic triad of walking, thinking, and bladder problems, despite normal-range CSF pressure.
In short: Normal pressure hydrocephalus (NPH)
- It mainly affects older adults.
- The classic triad is gait disturbance, cognitive impairment, and urinary incontinence.
- CSF pressure is typically within the normal range despite enlarged ventricles.
- It is one of the few potentially treatable causes of these symptoms, often with a shunt.
What it is
Normal pressure hydrocephalus (NPH) is a form of hydrocephalus, occurring mainly in older adults, characterized by enlarged ventricles and a classic triad of symptoms — walking difficulty, cognitive (thinking) decline, and urinary incontinence — even though the measured CSF pressure is usually within the normal range.
Understanding Normal pressure hydrocephalus (NPH)
Despite the name, subtle pressure changes are thought to play a role, even though spot measurements of CSF pressure are normal. The classic triad is sometimes remembered as "wet, wacky, and wobbly" (urinary, cognitive, and gait symptoms). Gait disturbance is often the earliest and most responsive symptom. NPH is important because it is one of the few causes of these symptoms that may improve with treatment — typically a shunt — distinguishing it from many untreatable causes of dementia and gait decline. Because its features overlap with other conditions of aging, careful evaluation (including imaging and tests such as a lumbar tap test) is used to identify who is likely to benefit from treatment.
Why it matters
Understanding NPH matters because it is a potentially treatable cause of walking, thinking, and bladder problems in older adults that can otherwise be mistaken for untreatable conditions. Recognizing it can open the door to treatment that may improve symptoms, especially gait.
Common questions
What is the classic triad of NPH?
Gait disturbance, cognitive impairment, and urinary incontinence.
Is the pressure actually normal?
Spot measurements are usually within the normal range, though subtle changes may play a role.
Can it be treated?
Yes — often with a shunt, with gait frequently the most responsive symptom.
Bottom line
Normal pressure hydrocephalus is a potentially treatable form in older adults with a triad of gait, cognitive, and bladder problems despite normal-range pressure.
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