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Normal pressure hydrocephalus, or NPH, is a condition in which cerebrospinal fluid accumulates within the brain's ventricles, causing them to enlarge. It matters because it can cause symptoms that resemble dementia—and, unlike many progressive causes of dementia, some patients improve with appropriate treatment.
Written and medically reviewed by Amarish Dave, DO, board-certified neurologist. This page is educational and does not replace an individual medical evaluation.
Walking problems are often one of the earliest and most prominent symptoms. A person may walk slowly, take short steps, have difficulty initiating walking, or appear as though their feet are stuck to the floor.
NPH can cause problems with thinking, attention, processing speed, memory and other cognitive functions. These changes can sometimes be mistaken for Alzheimer's disease or another dementia.
Urinary urgency, frequency and eventually urinary incontinence can occur. Caregivers can also review practical guidance on managing urinary incontinence in dementia.
Not every person with NPH will have all three symptoms, and other conditions can produce a similar pattern.
Memory and thinking problems in an older adult may have many potential causes. Alzheimer's disease is common, but clinicians should also consider other conditions when the history and examination suggest them—including Lewy body dementia, frontotemporal dementia and vascular dementia.
NPH is especially important to consider when cognitive changes occur together with a significant change in walking and urinary symptoms.
Diagnosis generally involves a combination of:
In selected patients, additional testing such as removal of cerebrospinal fluid with a lumbar puncture (a "tap test") may be performed to determine whether symptoms, particularly walking, improve temporarily. No single test proves NPH—the diagnosis rests on the overall clinical picture. Our video on what tests are ordered when evaluating dementia explains how imaging and laboratory testing fit into a broader dementia evaluation.
Yes. In appropriately selected patients, NPH can be treated with a surgically implanted shunt that drains excess cerebrospinal fluid, usually from the brain's ventricles to another part of the body such as the abdomen.
Some patients experience meaningful improvement after treatment, particularly in walking. Cognitive and urinary symptoms may also improve, although response varies between individuals.
Appropriate diagnosis and patient selection are important, because shunt surgery also has potential risks. Treatment decisions belong in a conversation with the treating physicians and surgical team.
Not every person with memory problems has Alzheimer's disease. A comprehensive memory loss and dementia evaluation is intended not only to identify Alzheimer's disease and other neurodegenerative disorders, but also to look for potentially treatable or contributing causes of cognitive impairment—NPH among them.
Learn what happens during a dementia evaluation, how normal aging differs from dementia, and how dementia is treated.
Explore memory loss and dementia evaluation, our Memory & Dementia hub, cognitive testing, mild cognitive impairment, and lifestyle and dementia, and what frontotemporal dementia is. Browse more answers in the Neurology Video Library.
More medically reviewed neurology videos appear here automatically as they are published.
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Amarish Dave, DO shares practical, dignity-centered strategies for scheduled toileting, safer bathroom access, simpler clothing, and recognizing changes that need medical evaluation.
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Memory & Dementia
Amarish Dave, DO explains frontotemporal dementia (FTD): early changes in personality, behavior, judgment and language, how it differs from Alzheimer's disease, and how it is evaluated.
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Memory & Dementia
Amarish Dave, DO explains how Leqembi and Kisunla target amyloid, who may qualify, and why biomarker confirmation, MRI monitoring, and individualized risk review matter.
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Memory & Dementia
Amarish Dave, DO explains Lewy body dementia, including changes in thinking and alertness, visual hallucinations, movement symptoms, and acting out dreams.
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Learn more about comprehensive memory and dementia evaluation at NeurologistCare.com. In-person neurological and memory evaluations are available in Crystal Lake and Woodstock, Illinois, and Lake Geneva, Wisconsin, with telehealth available when appropriate for patients located anywhere in Illinois or Wisconsin.
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