Signs, Symptoms & Clinical Features
NPH triad ("wet, wacky, wobbly")
The NPH triad is the classic combination of gait disturbance, cognitive impairment, and urinary incontinence in normal pressure hydrocephalus.
In short: NPH triad ("wet, wacky, wobbly")
- It combines gait, cognitive, and bladder symptoms.
- It is sometimes remembered as "wet, wacky, and wobbly."
- Not everyone with NPH has all three.
- Gait is often the earliest and most treatable.
What it is
The NPH triad is the classic combination of three symptoms in normal pressure hydrocephalus: gait disturbance (difficulty walking), cognitive impairment (thinking decline), and urinary incontinence (loss of bladder control). It is a hallmark of the condition.
Understanding NPH triad ("wet, wacky, wobbly")
The triad is sometimes remembered with the mnemonic "wet, wacky, and wobbly" (urinary, cognitive, and gait symptoms). In typical NPH, gait disturbance appears first and is often the most prominent and the most responsive to treatment, followed by cognitive and then bladder symptoms. However, not everyone with NPH has all three symptoms, and the symptoms overlap with other conditions of aging, so careful evaluation is needed. Recognizing the triad is important because NPH is one of the few causes of these symptoms that may improve with treatment (a shunt), distinguishing it from many untreatable conditions. The triad guides who is evaluated for NPH.
Why it matters
Understanding the NPH triad helps older adults and families recognize a pattern that, unlike many causes of these symptoms, may be treatable — making it important to evaluate when the triad is present.
Common questions
What are the three parts of the NPH triad?
Gait disturbance, cognitive impairment, and urinary incontinence.
What is the mnemonic?
"Wet, wacky, and wobbly."
Does everyone with NPH have all three?
No — not everyone has all three.
Bottom line
The NPH triad is the classic gait, cognitive, and bladder symptoms of normal pressure hydrocephalus — a potentially treatable pattern worth recognizing.
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