What kind of lifestyle can I expect to have while I have NPH?
The symptoms of abmornal gait, dementia and bladder control may improve within days of shunt surgery, or may take weeks to months to abate. Generally, patients with an implanted shunt system are not restricted in their daily activities, except those involving great physical exertion. Most patients can look forward to a normal future. But because hydrocephalus is an ongoing condition, patients do require long-term, follow-up care by a doctor. Regular checkups are sensible and encouraged.
What is the problem with cognitive function or dementia?
Most dementias are progressive, irreversible, and degenerative. However , with NPH, the dementia is often reversible, which is a good thing!
Dementia or loss of cognitive function usually shows up after the problems with walking occur. Dementia can show up in a variety of ways. There might be some loss of short term memory e.g., patients not recalling where they put their keys or not recalling what they had for breakfast. However, friend and family sometimes attribute this to “just getting older.”
In some situations, individuals lose interest in things they have previously enjoyed e.g., playing with grandchildren, playing cards, doing crossword puzzles, and so on.
The mood of some patients can be withdrawn or flat, without animation or noticeable excitement about things that previously the patient found fun and interesting.
It should be noted that NPH is sometimes confused with Alzheimer's disease, which is a dementia that is not reversible – however, the dementia from NPH is potentially reversible! There is some information that suggests 5% of those with dementia have NPH and could potentially be treated and relieved of this symptom.
Can you describe the problem(s) related to urinary incontinence?
This is a symptom of NPH that usually shows up later in the progression of the syndrome. Problems with urinary incontinence can be as mild as simply having to go to the bathroom frequently, which is common in the aging population anyway. However, some patients have a sense of urgency, and are not comfortable being far from a bathroom for fear of having an accident, while others simply have loss bladder control and are required to use adult diapers.
How common is NPH?
Although we do not have a definite number related to the incidence of NPH, it is thought to be increasing because of the aging of the population. According to the National Council on Aging (NCOA) there have been domestic estimates that range from 200,000 to 750,000 with 375,000 being the number most frequently quoted.
All patients will have a detailed history and a physical exam. This is generally followed by some imaging study such as a CT or MRI to check the size of the ventricles. There is typically routine lab work done and neuropsychological tests to evaluate cognition. A lumbar puncture is done to remove CSF, which will determine if symptoms improve so physicians can predict with some degree of certainty if the shunt will work.
