Normal Pressure Hydrocephalus (NPH) vs Alzheimer’s and Parkinson’s
If you or a loved one are experiencing memory loss, difficulty walking, or bladder control issues, it’s easy to assume it’s part of aging or a condition like Alzheimer’s, Parkinson’s disease, or multiple small strokes. However, normal pressure hydrocephalus (NPH) can cause similar symptoms and is often misdiagnosed. Unlike Alzheimer’s and Parkinson’s, NPH is treatable, and recognizing the difference is essential for getting the right care. Further complicating matters, NPH can co-exist with other conditions making symptoms worse and progress faster than if it were not a contributing factor.
What Is Normal Pressure Hydrocephalus (NPH)?
NPH is a build-up of cerebrospinal fluid (CSF) within lake-like compartments in the brain called the ventricles. This causes the ventricles to enlarge, sometimes with little or no increase in intracranial pressure (ICP). The enlargement imparts stress on surrounding brain tissue leading to symptoms that affect walking, thinking, and bladder control. NPH is most commonly seen in adults aged 60 or over. A recent study estimates that nearly 800,000 older Americans may be living with NPH, yet over 80% of cases remain unrecognized or untreated. Early diagnosis is crucial, as NPH is one of the few conditions that cause dementia-like symptoms but can often be reversed with treatment.
Key Symptoms of Normal Pressure Hydrocephalus (NPH)
NPH is often identified by three main symptoms:
- Difficulty walking –Difficulty walking or making turns, feeling like it’s hard to take the first step, balance issues, falling, a slow shuffling gait, trouble lifting feet, or feeling like your feet are “stuck” on the floor.
- Cognitive changes – Problems organizing or planning tasks, hard time multitasking, trouble listening or paying attention, short-term memory issues, feeling withdrawn, talking less, poor handwriting, trouble with simple math calculations
- Bladder problems – Trouble “holding it”, not able to get to the bathroom fast enough, experiencing accidents
Since these symptoms develop gradually, they are often mistaken for Alzheimer’s or Parkinson’s. But there are key differences.
How Normal Pressure Hydrocephalus (NPH) Differs from Alzheimer’s
| Symptom | NPH | Alzheimer’s |
| Memory Problems | Mild to moderate, may improve with treatment | Progressive, worsens over time |
| Walking Issues | One of the first symptoms | Not common in early stages |
| Bladder Problems | Frequent, may start early | Rare in early stages |
| Response to Treatment | Often improves with a shunt | Newer medications slow progression but do not cure |
Key Differences
Memory issues in NPH are milder and can improve with treatment, while Alzheimer’s leads to severe, irreversible memory loss. Walking problems in NPH appear early, while Alzheimer’s patients may not struggle with movement until much later.
How Normal Pressure Hydrocephalus (NPH) Differs from Parkinson’s
| Symptom | NPH | Parkinson’s |
| Walking Issues | Slow, shuffling gait with balance problems | Small, rigid steps, often with tremors |
| Hand Tremors | Not present | Common, especially at rest |
| Muscle Stiffness and slowness | Not a major symptom Upper limbs not affected |
Significant stiffness (rigidity) affecting upper and lower limbs |
| Response to Treatment | Does not respond to medication but can improve with shunt surgery | Initially responds to medication but worsens over time |
Key Differences
Unlike Parkinson’s, NPH does not cause tremors or muscle stiffness. Both conditions affect movement with similar walking characteristics, but Parkinson’s patients exhibit stiffness and slowness of the arms and legs and have a narrower gait as opposed to a broad-based gait in NPH. They can also show decreased facial expressivity, trouble swallowing, difficulty controlling salivation, and might also have low blood pressure upon standing.
Getting the Right Diagnostic
Because NPH symptoms overlap with Alzheimer’s and Parkinson’s, proper testing is key. A neurologist or neurosurgeon may use:
- Brain Imaging (MRI or CT Scan) – Checks for enlarged brain ventricles, a sign of NPH.
- Lumbar Puncture (Spinal Tap) – A large amount of CSF is removed to see if symptoms improve, which suggests NPH.
- Extended CSF Drainage (Drain Trial) – A temporary spinal drain is placed for a few days to assess whether removing excess fluid leads to improvement.
If walking, memory, or bladder issues improve significantly after these tests, a shunt procedure may be recommended to provide long-term symptom relief.
Early Diagnosis Can Lead to Effective Treatment
Unlike Alzheimer’s and Parkinson’s, which progress over time and have no cure, NPH can often be treated. Many people with NPH see significant improvements in walking, thinking, and bladder control after shunt surgery. If you or a loved one are experiencing these symptoms, talk to a doctor about testing for NPH. The right diagnosis can make a life-changing difference.
Information you can trust! This article was produced by the Hydrocephalus Association, copyright 2025. We would like to thank James Golomb, MD and Abhay Moghekar, MD for their valuable contribution and expert input.
This article is designed to provide helpful information on the subjects discussed. It is not intended as a substitute for treatment advice from a medical professional. For diagnosis or treatment of any medical condition, consult your doctor.