Does your elderly person have these symptoms? Let's learn about normal pressure hydrocephalus (NPH)

Have you ever noticed that your elderly mother, father, or grandmother is losing her memory and finding it difficult to walk as she gets older? Sometimes we think that these are normal things that happen as we get older. However, sometimes there may be another reason behind these conditions. Today, we are going to talk about a special condition that may look like dementia, but can be cured if treated . That is a condition called `(Normal Pressure Hydrocephalus)` or `(NPH)`.

What is `(Normal Pressure Hydrocephalus - NPH)`?

Simply put, `(Normal Pressure Hydrocephalus)` or `(NPH)` is a condition where fluid builds up in or around our brain, interfering with brain function . Think of it like a bucket full of water. This can affect many of the functions controlled by the brain, such as thinking, focusing, memory, and walking. The special thing is that although the symptoms of this are very similar to dementia, the condition `(NPH)` can sometimes be treated and cured .

Who is most affected by this `(NPH)` condition?

This condition, called ``(NPH)`` , is most common in people over the age of 65. The risk of developing this condition increases with age. It usually begins around the age of 70.

Increasing age is the main risk factor for this. Things like race, color, and gender do not affect this.

How common is `(NPH)`?

Although relatively uncommon, NPH is a well-known condition among doctors. It is estimated that about 0.2% of people between the ages of 70 and 80 have the condition, and about 5.9% of people over the age of 80 have it. That means that about 8.4 million people over the age of 80 worldwide suffer from this condition. According to experts, it is very rare in people under the age of 65, affecting only 0.003% of that age group.

What happens when you have `(NPH)`? How does it affect the brain?

NPH is caused by a buildup of a fluid called cerebrospinal fluid (CSF) in the brain . This fluid is like water. It nourishes the brain and removes waste products. The average adult brain contains about 150 milliliters (5 ounces) of CSF. That's less than half the amount in a can of Coke. Our bodies constantly make, circulate, and reabsorb this fluid to keep it at a constant level.

Although this fluid is small in amount, it plays a big role. This ``(CSF)`` fluid surrounds our brain and the spinal cord inside the spine. In other words, our brain floats in this fluid . It also acts as a cushion that protects the brain and spinal cord from external shocks.

So, if our body is unable to circulate this ``(CSF)`` fluid properly or reabsorb it, this fluid starts to accumulate more than it should inside the skull.

In `(NPH)`, this fluid builds up slowly, so even though the pressure inside the skull `(Intracranial Pressure)` is increased, it remains within the normal range . (That's why it's also called `(Normal Pressure Hydrocephalus)` - "Normal Pressure Hydrocephalus"). Because, inside our brain there are fluid-filled cavities called `(Ventricles)`, which can handle some of this fluid buildup.

But, as the `(CSF)` continues to accumulate, there is nowhere else for that fluid to go. Then, the brain begins to swell and swell . That is what causes the symptoms of this disease. If the brain swells like this for a long time, the pressure can cause permanent damage to the brain tissue, or even destroy it.

What are the symptoms of `(NPH)`?

The symptoms of `(NPH)` usually develop slowly, gradually increasing over a period of three to six months . There are three main symptoms of `(NPH)`, also known as Hakim's Triad . Between 50% and 75% of people with `(NPH)` have all three symptoms at the same time. Hakim's Triad includes the following three types of symptoms:

• Gait issues
• Urinary incontinence
• Cognitive difficulties

Difficulty walking

These are problems with movement related to walking. This symptom is the most common of the three. Between 80% and 95% of people with NPH have these symptoms. Some of the symptoms can be similar to the movement disorders of Parkinson's disease , but the main difference is that in NPH, these symptoms are usually limited to the legs and feet.

If you have `(NPH)`, these things may happen:

• It becomes difficult to lift the legs . This makes the legs seem stuck to the ground when walking. It is said to be like the difficulty of trying to remove a magnet from a surface.
• The feet are small and wobbly . This makes it look like the legs are dragging when walking. There is also a high chance of stumbling and falling.
• Walking may stop suddenly or walk uncertainly . It may seem as if you cannot decide whether to take a step or move forward after starting to walk. You may also hesitate when making large turns while walking, and may have difficulty turning.
• When walking, the toes of the feet are turned outwards . This allows them to spread their legs apart and walk side to side, like a penguin.

Inability to control urine

This is the loss of bladder control and the involuntary leakage of urine. In the early stages, you may feel the need to urinate frequently, or you may feel a sudden, overwhelming need to urinate that is difficult to control.

People with this trait may feel embarrassed if they lose control of their urine. However, some people do not even notice this or feel any shame . This may be due to the difficulty in thinking, which is the third characteristic of Hakeem's triad.

Difficulty thinking and remembering

The third main feature of NPH is difficulty with thinking and memory. This can cause things like:

• Mental and physical slowness . A person seems to think and act more slowly than usual.
• Memory problems . You often forget things and seem to be working without thinking.
• Executive dysfunction : Difficulty managing emotions, thoughts, and actions. Difficulty concentrating, making decisions, and having trouble thinking clearly.
• Changes in emotions . People with NPH may seem apathetic and lose interest in things they used to enjoy.

What are the causes of `(NPH)`?

There are two main types of `(NPH)`, both of which occur in the same way. The two types are:

• Primary (idiopathic) NPH
• Secondary NPH

Primary (cause unknown) `(NPH)`

Primary NPH means that it is not caused by another medical condition. Another term for this is idiopathic , which is a term used by specialists to describe conditions that develop without a specific cause . Experts believe that idiopathic NPH may be related to one or more problems that occur with aging in the way our bodies make, circulate, and reabsorb cerebrospinal fluid (CSF). About half of all NPH patients fall into this category.

Under normal circumstances, our bodies produce between 400 and 600 milliliters of `(CSF)` per day. That's more than we need. Therefore, we have to keep reabsorbing old `(CSF)` to make room for new `(CSF)`. If there is a problem with the way `(CSF)` circulates or is reabsorbed, the body can make more `(CSF)` than it needs, causing this fluid to build up.

There is also evidence that NPH may be linked to degenerative brain diseases such as Alzheimer's disease and Lewy body dementia . Researchers are still trying to figure out how and why NPH develops, and whether other conditions can affect it. Answering these questions could help prevent or better treat the condition in the future.

Secondary `(NPH)`

Secondary NPH occurs when another medical condition affects the way our body makes, circulates, or reabsorbs cerebrospinal fluid (CSF). Some conditions that can cause secondary NPH include:

• A brain aneurysm (a bulge in a blood vessel that can rupture and bleed into brain tissue).
• Bleeding in or around the brain (Intracranial hemorrhage).
• Brain tumors (including cancer)
• Infections of the brain or related parts of the nervous system (for example , encephalitis or meningitis ).
• Stroke .
• Traumatic brain injuries (TBI) include injuries to the brain or related areas during medical treatment.

How is `(NPH)` diagnosed?

Diagnosing NPH is a bit tricky, because many of the symptoms of the condition are similar to those of other age-related diseases, such as dementia . NPH is also common in conjunction with other age-related diseases. About 30% of people with NPH also have Alzheimer's disease or a similar brain disease.

A doctor diagnoses NPH using a combination of these methods:

• Physical and neurological exam . In this, the doctor looks for visible signs of illness. He or she also tests your senses (sight, hearing, touch), reflexes, and muscle strength in your limbs.
• Asking about your medical history and symptoms . Your medical records, medical history, and symptoms can provide important clues to diagnosing NPH.
• Diagnostic imaging . Magnetic resonance imaging (MRI) scans are the most important tool in diagnosing NPH. This allows the doctor to look inside your head and see the brain and areas where fluid has collected. Your doctor may also order a cisternogram scan , but this is not common. Computed tomography (CT) scans can help rule out other conditions, but they are not very helpful in diagnosing NPH.
• Lab tests . A lumbar puncture ( a procedure that involves taking a small amount of fluid from the spine) allows the doctor to take a sample of the cerebrospinal fluid (CSF) for testing. This cannot directly diagnose NPH, but it can help rule out other conditions. It can also help diagnose if NPH is caused by another condition, such as meningitis. A lumbar puncture can also remove some of the excess CSF, which may temporarily relieve symptoms (but symptoms will return when the CSF is added back).

Depending on your symptoms, your doctor may also order other tests. These are usually to rule out other conditions that have similar symptoms to NPH. Your doctor will tell you more about these tests and why they are important.

How is `(NPH)` treated? Is there a complete cure for this?

For the most part, NPH is a treatable condition . Treatment varies depending on whether it is primary/idiopathic or secondary. Unlike many other brain disorders, medications are rarely used to treat NPH. This is because NPH is often unresponsive to medication (although some symptoms associated with NPH can be treated with medication).

Treatment of primary/idiopathic `(NPH)`

Primary/unknown cause (NPH) is usually treatable. The most common – and most successful – treatment for this is the surgical insertion of a device called a shunt . A shunt has two tubes (catheters), one to let fluid in and one to let it out, with a valve between the two. If the ventricles of the brain become too full of fluid, the increased pressure forces the fluid into the inlet tube, opening the valve and allowing the excess fluid to flow out through the outlet tube.

Some newer shunt valves are made ``programmable,'' meaning that the doctor can change their settings without surgery. They are visible on an ``X-ray,'' so the doctor can look at the valve and make sure that the settings are correct. Some newer shunts are ``MRI-safe,'' meaning that you can have an ``MRI'' scan even if you have this type of valve.

The drainage tube comes out through a small hole in the skull (the doctor makes this hole during the surgery to insert the shunt). After exiting the skull, the tube turns downward and goes under the skin. This drainage tube directs the fluid to the chest or abdomen.

If the tube is directed into the abdomen (which is most often done), the fluid is sucked from the peritoneum, the membrane that surrounds many of the abdominal organs. If it is directed into the chest, the CSF is sucked from the pleural membrane that surrounds the lungs.

Secondary `(NPH)`

Secondary NPH may be curable, but only if the condition is caused by a treatable condition . Treatment for secondary NPH can vary greatly depending on the underlying cause. Your doctor is the best person to talk to about the treatments available and what they recommend.

What are the side effects or complications of the treatment?

The side effects of treating NPH vary depending on the treatment. In primary/unknown NPH, the most common treatment is surgically placing a shunt to stop the excess CSF from accumulating inside the skull. Some of the side effects of this surgery include (but are not limited to):

• Infections
• Shunt malfunction or failure
• Position shifts in the valve and/or tubes
• Excessive leakage of `(CSF)` through the shunt (this causes a decrease in `(CSF)` pressure, also called `(Intracranial hypotension)` ).

In secondary NPH, the treatments available can vary. Also, the side effects and complications can vary. Therefore, your doctor is the best person to tell you what complications or side effects you can expect and what can be done about them.

How can I manage symptoms if I don't take care of myself?

NPH is not a condition that you can diagnose or treat on your own. Therefore, do not ignore the symptoms or try to treat yourself or someone else with these symptoms on your own .

How soon will I feel better after treatment? How long does it take to recover from treatment?

The symptoms of this condition can begin to improve almost immediately with the placement of a shunt. The sooner the diagnosis and treatment are made, the more successful it is.

Most people notice a reduction in symptoms within a few hours or days after having a shunt placed. However, because a shunt is a major surgery, it can take many people several days or weeks to recover from it. Your doctor will be the only one who can tell you exactly how long it will take to recover from surgery, as many factors affect your recovery time.

Can I reduce the risk of developing (NPH) or prevent it altogether?

NPH occurs unexpectedly, and about half of cases are idiopathic, meaning they develop for no known reason. Idiopathic NPH cannot be prevented , nor can the risk of developing it be reduced.

However, you can reduce your risk of developing secondary NPH by avoiding other diseases or conditions that can cause this condition. Here are some things you can do:

• Don't ignore infections , especially eye and ear infections. These can easily spread to the brain and cause conditions like encephalitis or meningitis .
• Wear protective equipment . Traumatic brain injuries can cause secondary NPH. Wearing protective equipment like a helmet can help prevent these injuries.
• Control your health conditions . Conditions like high blood pressure can cause brain aneurysms and bleeding in the brain. Both of these can cause NPH. Controlling your blood pressure and managing conditions like type 2 diabetes or high cholesterol can reduce your risk of these problems.

What should I expect if I have `(NPH)`?

NPH is a special case of dementia-like conditions because it can often be reversed . However, the best chance of reversing this condition is with early diagnosis and early treatment . The later the diagnosis and treatment, the more likely it is that the damage to the brain caused by the stress will be permanent and severe.

Because NPH usually affects your ability to think, many people with the condition don't know they have it. Family, friends, and acquaintances are often the first to notice the symptoms of NPH . This means that loved ones can play a big role in getting NPH diagnosed and treated early.

How long has `(NPH)` been around?

NPH is a chronic condition . Symptoms develop slowly over a period of three to six months. However, NPH does not get better on its own; it continues to get worse. As it gets worse, it can eventually cause severe and permanent brain damage.

While NPH may not be fatal on its own, it can cause symptoms that make it difficult and ultimately impossible for a person to live independently. It can also contribute to serious, life-threatening complications, such as falls.

With treatment, the main symptoms of `(NPH)` are likely to improve. With treatment, the likelihood of those three symptoms improving is as follows:

• Difficulty walking : These symptoms resolve in about 85% of treated patients.
• Incontinence : This symptom is curable in about 80% of cases if treated early. The chance of cure is between 50% and 60% if treated late.
• Thinking and memory difficulties : These symptoms improve in about 80% of treated patients.

What is the outlook for this situation?

The outlook for `(NPH)` can vary greatly. The reasons for this are:

• NPH is difficult to diagnose because its symptoms are similar to those that occur normally with aging, or to other age-related diseases.
• The symptoms of `(NPH)` progress slowly.
• About a third of people with NPH also have a degenerative brain disease like Alzheimer's disease.
• NPH becomes more common as we age, and many common age-related health conditions can contribute to and worsen NPH.
• Because the symptoms of `(NPH)` affect your ability to think, you may not be able to recognize your symptoms yourself.

Factors affecting `(NPH)` results

If these factors are present, the chances of getting a good result from `(NPH)` are high:

• Early diagnosis and treatment.
• Difficulty in walking and/or urinary control followed by difficulty in thinking and memory.
• Secondary NPH occurs due to curable or reversible causes.
• When the CSF is removed during a lumbar puncture, the symptoms of NPH decrease.

The chances of a good outcome are low if these factors are present:

• Delay in diagnosis and treatment.
• Early onset of thinking and memory problems, especially if they begin before difficulty walking or urinary control.
• Severe thinking and memory difficulties.
• Having other brain diseases (especially degenerative brain diseases like Alzheimer's disease).

Because many factors affect the outcome, your doctor is the best person to talk to about the likely outcome for you or a loved one with this condition. The information they provide will include your medical history, the severity of your symptoms, possible treatments, and other important details.

How do I take care of myself (after having a shunt)?

If you have NPH, the most likely treatment you will receive is surgery to place a shunt to stop fluid from building up inside the brain. If you have a shunt, there are usually a few things you can do to help prevent problems:

• Follow your doctor's instructions after surgery . It's especially important to take good care of the areas where stitches or staples were placed. Taking good care of these can help prevent complications like infections.
• Stay away from magnets if necessary . Not all shunts have magnetic valves, so this is not something everyone with a shunt should do. Your doctor will talk to you about this.
• Be careful with movements and activities . Avoid physical activities that could affect the shunt, the tube, or anything else.
• See your doctor as recommended . It is important to see your doctor regularly to prevent complications from this condition. During these visits, your doctor can monitor your condition and adjust the shunt if necessary.
• Watch for symptoms . If you notice any of the symptoms of `(NPH)` reappearing, tell your doctor as soon as possible. Recurring symptoms may indicate a problem with the shunt. The longer the symptoms persist and worsen, the greater the risk of complications.

When should I see my doctor?

You should see your doctor as recommended. You should also see your doctor if you notice any recurrence of your NPH symptoms, or if you experience any new symptoms (even if they seem unrelated).

When should I go to the Emergency Department (ETU) ?

Your doctor will tell you about symptoms that may indicate possible problems or complications. Some symptoms that are more likely to require immediate medical attention include:

• Headaches . Headaches that interfere with your normal activities, especially if they start or worsen when you sit or stand up. These can be caused by a problem with the shunt (if it is not draining enough CSF), or if the shunt is out of place.
• Fever or chills . Infections can develop after shunt surgery. These infections can affect your brain, spinal cord, or peritoneum, and can spread quickly. Never ignore signs of infection after a (NPH) surgery.
• Stiff neck . This could be a problem with the shunt or the outflow tract.
• Pain in the abdomen or chest where the tube is . If the tube moves, it can pinch or damage nearby tissues. If you have pain in these areas, especially if it comes on suddenly and is severe, you should call your doctor or go to the emergency room right away.

There may be other symptoms you should be aware of, and your doctor will tell you more about them. He or she is also the best person to answer questions about what you can do to prevent these problems.

What is the difference between `(Normal Pressure Hydrocephalus - NPH)` and `(Hydrocephalus)`?

NPH is a condition called hydrocephalus (water head) that develops slowly and gets worse over time. "Normal pressure" means that the pressure inside your skull (intracranial pressure - ICP) is not abnormally or dangerously high. In these cases, your ICP level may be near the upper end of the expected range. This happens slowly, squeezing and squeezing your brain tissue. The pressure is relatively normal, so the brain has time to let the fluid out, which is what ultimately causes symptoms.

Finally, what to remember (Take-Home Message)

Normal Pressure Hydrocephalus (NPH) is a rare condition that most commonly affects people over the age of 65. It can be idiopathic, caused by an infection such as meningitis, or caused by an injury to part of the brain. This condition can cause dementia-like symptoms , affecting walking, thinking, and the ability to control urine.

Many conditions that look like dementia only get worse over time and are difficult to treat and manage. However, NPH is often treatable, and sometimes reversible . The best chance of reversing the effects of NPH is if it is diagnosed early and treated early. That’s why it’s important not to ignore your symptoms or those of a loved one. With prompt treatment, many people with NPH can recover and regain most – or all – of their pre-existing abilities.

Remember, if you have any doubts about this, it is best to seek medical advice.

` Pressure on the brain, NPH, aging, difficulty walking, urinary control, memory loss, shunt surgery