The Challenges of Normal Pressure Hydrocephalus: A Case-Based Review

Clinician Reviews. 2015 December;25(12):44-49
December 1, 2015 | Clinician Reviews
Freddi Segal-Gidan, PA, PhD
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Freddi Segal-Gidan

Freddi Segal-Gidan is Director of the Rancho Los Amigos/University of Southern California (USC) Alzheimer’s Disease Center and Assistant Clinical Professor in the departments of Neurology and Family Medicine at Keck School of Medicine, USC, and in Gerontology at L. Davis School of Gerontology at USC, Los Angeles.

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Idiopathic normal pressure hydrocephalus (iNPH) is one of the few reversible causes ofdementia. Unfortunately, the symptoms of iNPH—cognitive impairment, gait change, andurinary incontinence—develop slowly and are often mistaken for those ofother conditions or for normal aging. This article explains when to suspect iNPHand the steps you need to take when iNPH is in the differential.

EPIDEMIOLOGY
The prevalence of iNPH has been estimated at 21.9 cases per 100,000 persons.6 It occurs primarily in individuals older than age 606 and occurs more frequently with increasing age, as shown in a recent report in which the prevalence of probable iNPH was 0.2% in those ages 70 to 79 and 5.9% in those ages 80 and older.7 Based on these numbers, the authors estimated that approximately 700,000 Americans older than 70 may have iNPH. It is a rare cause of dementia among the population with dementia onset after age 65 (“senile onset”). No gender or racial/ethnic differences have been reported.

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