Symptoms of NPH

Characterized by three primary symptoms, NPH patients usually exhibit:

  • Gait disturbance (difficulty walking)
  • Dementia or forgetfulness
  • Urinary incontinence (bladder control)

However, not all symptoms are always apparent or present at the same time.

View a video of the NPH gait


Because these three symptoms are often associated with the aging process in general, and a majority of the NPH population is older than 60 years, people often assume that they must live with the problems or adapt to the changes occurring within their bodies. Symptoms can be present for months or even years before a person sees a physician. The symptoms of NPH seem to progress with time. The rate of progress is variable, and it is often a critical loss of function, or disability, that brings patients to their doctors. It seems that the longer the symptoms have been present, the less likely it is that treatment will be successful. As a general rule, the earlier the diagnosis, the better the chance for successful treatment, but some people experiencing symptoms for years can improve with treatment.


Gait disturbances range in severity, from mild imbalance to the inability to stand or walk at all. For many patients, the gait is wide-based, short, slow and shuffling. People may have trouble picking up their feet, making stairs and curbs difficult and frequently resulting in falls. Gait disturbance is often the most pronounced symptom and the first to become apparent.


Mild dementia can be described as a loss of interest in daily activities, forgetfulness, difficulty dealing with routine tasks and short-term memory loss. People do not usually lose language skills, but they may deny that there are any problems. Not everyone will have an obvious mental impairment.


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, fecal incontinence may occur. Some patients never display signs of bladder problems.

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