Normal Pressure Hydrocephalus (NPH)
What are the Signs of Normal Pressure Hydrocephalus (NPH)?
Normal pressure hydrocephalus is usually characterized by a three symptoms:
- complaints of gait disturbance (difficulty walking)
- mild dementia
- and impaired bladder control.
These symptoms may not occur all at the same time. Sometimes only one or two of the symptoms are present.
Gait disturbances range in severity from mild imbalance to the inability to stand or walk at all. Gait is often wide based, short-stepped, slow and shuffling. People with NPH may have trouble picking up their feet, climbing stairs, getting up a curb, and experience frequent falls. They may have difficulty turning around, and turn very slowly with multiple little steps.
Gait disturbance is often the most pronounced symptom and the first to become apparent. In other words, if you notice a loved on is having problems walking, or the sound of their feet on the ground changes, you should be concerned.
Most of the above symptoms occur to the elderly and just about everyone will diagnose it as part of getting old.
Mild dementia (mild cognitive impairment) can be described as a loss of interest in daily activities, forgetfulness, difficulty dealing with routine tasks, and short-term memory loss.
The cognitive symptoms associated with NPH are usually less severe than full-blown
dementia, and are often overlooked for years or accepted as an inevitable consequence of aging. People with NPH do not usually lose language skills, but they may be less
aware of their deficits than those around them, and may even deny that there are any problems.
Not all individuals have an obvious cognitive impairment. In mildly affected
cases, conversational skills may be preserved and thinking abilities may be relatively unchanged. In some cases, cognitive changes may only be detectable with formal neuropsychological testing.
Impairment in bladder control is usually characterized by urinary frequency and urgency in mild cases, whereas a complete loss of bladder control (urinary incontinence) can occur in more severe cases.
Urinary frequency is the need to urinate more often than usual, sometimes as often as every one to two hours. Urinary urgency is a strong, immediate sensation of the need to urinate. This urge is sometimes so strong that it cannot be held back, resulting in incontinence. In very rare cases, faecal incontinence may occur. Some people never display signs of bladder problems.
Symptoms of NPH can also resemble those of other conditions affecting the elderly.
For example, the cognitive deficits of NPH can resemble those associated with early Alzheimer’s or dementia. The gait disturbances of NPH can look similar to those of Parkinson’s and Alzheimer’s.
Mild Cognitive Impairment (MCI)
Memory loss has long been accepted as a normal part of ageing. Recently there has been increasing recognition that some people experience a level of memory loss greater than that usually experienced with ageing, but without other signs of dementia. This has been termed Mild Cognitive Impairment (MCI).
Some people with mild cognitive impairment go on to develop dementia. For others, the symptoms of mild cognitive impairment do not progress to dementia, and some people who have mild cognitive impairment at one point in time later revert to normal cognitive status.
As MCI has only recently been defined, there is limited research on it and there is much that we do not yet understand.
Many people who have Parkinson’s disease develop dementia in the later stages of the disease.
The hallmark abnormality is Lewy bodies (abnormal deposits of the protein alpha-synuclein) that form inside nerve cells in the brain.
Creutzfeldt-Jakob disease is a rapidly fatal disorder that impairs memory and coordination and causes behavioural changes.
“Variant Creutzfeldt-Jakob disease” is believed to be caused by consumption of
products from cattle affected by “mad cow disease.”
Caused by the misfolding of prion protein throughout the brain.
Note: there are more than 100 types of dementia. Those listed here are the most common.