Normal Pressure Hydrocephalus: An Emerging Dilemma in the Elderly

Abstract

Normal pressure hydrocephalus (NPH) is a brain disorder that normally occurs in older adults. It deteriorates functional status and quality of life, particularly ambulation, micturation control, and cognitive ability. NPH patients for which there is no identifiable cause are classified as idiopathic NPH, while cases with preceding insults are classified as secondary NPH. Diagnosis is crucial and mainly relies on clinical information and brain imaging. Occasionally, therapeutic diagnosis by spinal tap test is required. Surgery for permanent cerebrospinal fluid (CSF) diversion is the mainstay treatment for this condition. Early surgical treatment usually results in favorable outcome. Most NPH patients are elderly and often have associated major medical conditions, so the benefits of CSF diversion should be weighed against the risks associated with the procedure. Ventriculoperitoneal (VP) shunt is the most commonly used procedure, with lumboperitoneal (LP) shunt being used with increasing frequency in the treatment of NPH.

Keywords

• Normal pressure hydrocephalus; elderly; shunt surgery