The Hidden Dementia – Idiopathic Normal Pressure Hydrocephalus (iNPH)


iNPH can be Treated or Reversed

There is a form of dementia that can resemble Parkinson’s disease or Alzheimer’s disease, but while Parkinson’s and Alzheimer’s are largely incurable, this particular dementia called idiopathic normal pressure hydrocephalus (iNPH) can be treated or even reversed. However, there are also cases that are a mixture of Parkinson’s or Alzheimer’s with hydrocephalus that make both the diagnosis and the treatment more complicated.

Symptoms for iNPH

The Hydrocephalus Association estimates that there are about 700,000 American seniors with this particular kind of dementia. It usually comes on around the age of 70 and targets men and women equally, unlike Alzheimer’s disease which attacks women more than men. The three main symptoms are problems with walking, lack of bladder control and other neurological signs of dementia. Unfortunately, these are also typical for Parkinson’s and Alzheimer’s.

Diagnosis CT or MRI

The only way to know if this is iNPH is to have a CT or MRI which will show if there is a buildup of cerebrospinal fluid in the brain that is putting pressure on the brain leading to symptoms of dementia. Doctors look to see if any of the four ventricles in the brain are enlarged. If evidence of buildup of cerebrospinal fluid putting pressure on the brain is found, then they will do a spinal tap from the lumbar region of the spine to drain out some fluid, so that they will be able to determine if the patient can be treated with a shunt and can have the necessary neurosurgical procedure.

Shunt Therapy

A shunt regulates the amount of cerebrospinal fluid and sends the excess fluid to somewhere else in the body like the bladder from where it can be expelled. Patients who are found suitable for shunt therapy can have more than 80% reversal of dementia symptoms. The shunt has to be put in place by a neurosurgical procedure, which is not without risk.

The Hydrocephalus Association

If you have a loved one who has a shuffling gait, has lost bladder control and is either depressed or showing other neurological symptoms, then get him/her off to a doctor who can order an MRI or CT. The Hydrocephalus Association can direct you to a doctor that specializes in diagnosing iNPH. An MRI is safer because it does not have radiation, but CTs are cheaper. See what their health plan will cover. It is estimated that less than 20% of iNPH dementia patients fall through the cracks and do not get diaagnosed. However, it is certainly worth making the attempt to get a real proper diagnosis because if iNPH is found to be the dementia, you may have more than 80% of a chance to get your loved one back again.

Help for Caregivers

The Hydrocephalus Association has all kinds of resources and tools to help caregivers of iNPH patients. Caregivers may be spouses or children. Some of the resources are fact sheets about shunt therapy or getting a second opinion. They also have books, a library.


Since iNPH is treatable and reversible patients with the 3 main symptoms shuffling gait, incontinence and neurological signs of dementia should be sent for CT or MRI evaluation.

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