What age does NPH usually start? Understanding the Onset

According to the Hydrocephalus Association, an estimated 800,000 Americans may be living with Normal Pressure Hydrocephalus (NPH), with most cases remaining undiagnosed. Given this, it is crucial to understand what age does NPH usually start and recognize its often subtle symptoms early on.

Quick Summary

Normal Pressure Hydrocephalus (NPH) most commonly affects individuals over the age of 60, with the incidence increasing significantly after age 65. The condition typically develops gradually, often with symptoms appearing over a period of three to six months.

Key Points

• Typical Age of Onset: NPH most commonly affects individuals aged 60 and over, with the average age for the condition to begin being around 70 years old.

• Hakim's Triad: The condition is identified by three hallmark symptoms: gait disturbance (difficulty walking), cognitive impairment (mild dementia), and urinary incontinence.

• Differentiating from Normal Aging: NPH symptoms are often mistakenly attributed to normal aging, Alzheimer's, or Parkinson's, but unlike these, NPH is often treatable.

• Two Types of NPH: Idiopathic NPH has no known cause and is more common in older adults, while Secondary NPH results from a specific event like a head injury, infection, or hemorrhage.

• Treatment and Prognosis: With early diagnosis and shunt surgery, symptoms can significantly improve or even reverse, offering a much better prognosis than for other forms of dementia.

• Diagnostic Testing: The diagnostic process often includes a clinical evaluation, brain imaging (MRI/CT), and a trial removal of cerebrospinal fluid (CSF) via a lumbar puncture to confirm the diagnosis.

Unpacking the Typical Age of Onset for NPH

Normal Pressure Hydrocephalus (NPH) is primarily a condition affecting older adults, with the most common age of onset occurring after 60, and the average age around 70. The likelihood of developing NPH increases with age. Its symptoms are often subtle and can be mistaken for normal aging or other conditions like Alzheimer's or Parkinson's disease. This can delay diagnosis and treatment.

The 'Hakim Triad' and Symptom Progression

NPH is characterized by a specific group of three symptoms, known as the 'Hakim Triad,' which tend to develop gradually over several months. These symptoms include:

• Gait Disturbance: Difficulty walking is often the first symptom. This can present as a slow, shuffling, wide-based, or unsteady walk, with individuals feeling as though their feet are stuck.
• Cognitive Impairment: Mild dementia, characterized by forgetfulness, slowed thinking, and difficulty with daily tasks, is another key symptom.
• Urinary Incontinence: Problems with bladder control, such as increased urgency or loss of control, can also occur.

Idiopathic vs. Secondary NPH

NPH is classified into two types based on its cause:

Idiopathic NPH

• This is the more common form, where there is no clear cause.
• It is believed to be related to age-associated changes in how the body handles cerebrospinal fluid (CSF).

Secondary NPH

• This type results from a specific medical event that affects CSF flow.
• Causes can include head injuries, subarachnoid hemorrhage, meningitis, or brain tumors.
• Secondary NPH can affect individuals at any age.

Comparison: NPH vs. Other Aging Conditions

Distinguishing NPH from other conditions with similar symptoms is vital for proper treatment. A key comparison is with Alzheimer's disease:

Feature	Normal Pressure Hydrocephalus (NPH)	Alzheimer's Disease
Symptom Order	Gait issues often appear first.	Memory loss is typically the earliest symptom.
Gait	Distinctive walking problems are common.	Walking problems appear in later stages.
Reversibility	Often reversible with treatment.	Progressive and irreversible.
Memory Impairment	Tends to be milder and may improve with treatment.	Severe and progressive memory loss.
Cause	Idiopathic or secondary to other events.	Caused by brain plaques and tangles.

Diagnostic Process and Treatment

Early diagnosis of NPH is essential because it is often treatable. The diagnostic process typically involves:

1. Clinical Evaluation: A doctor assesses symptoms and medical history.
2. Brain Imaging: MRI or CT scans check for enlarged ventricles.
3. Cerebrospinal Fluid (CSF) Tests: A spinal tap or lumbar drain trial can help confirm the diagnosis by seeing if symptoms improve after removing some CSF.

The primary treatment for NPH is shunt surgery, which diverts excess CSF and can significantly improve symptoms in many patients, especially when diagnosed early.

Conclusion: Recognizing a Treatable Condition

The answer to what age does NPH usually start highlights that it is primarily a condition of older adults, often after age 60. Recognizing NPH symptoms and distinguishing them from normal aging or other dementias is crucial due to its potential for reversibility with treatment. Early diagnosis and intervention, particularly with shunt surgery, can significantly improve the quality of life for those affected. Increased awareness among individuals, families, and healthcare providers is key to ensuring proper diagnosis and treatment. For further information, the Hydrocephalus Association offers valuable resources.

Visit the Hydrocephalus Association for more information on NPH.

Frequently Asked Questions

Is NPH a normal part of aging?

No, NPH is not a normal part of aging. While it is more common in older adults, the symptoms—including changes in gait, cognitive function, and bladder control—are signs of a treatable medical condition, not the inevitable decline of getting older.

Can NPH occur in younger people?

Yes, but it is very rare. Secondary NPH, which is caused by a head injury, infection, or other known event, can occur in younger individuals. However, the idiopathic (cause unknown) form is almost exclusively a condition of older adulthood.

What is the key difference between NPH and Alzheimer's disease?

A key difference is that NPH is often reversible with treatment (shunt surgery), while Alzheimer's is progressive and irreversible. Additionally, gait disturbance is a defining early symptom of NPH, whereas it appears much later in Alzheimer's patients.

How long do NPH symptoms take to develop?

The symptoms of NPH usually develop gradually over a period of three to six months. They often worsen over time if the condition is left untreated.

Why is NPH often misdiagnosed?

NPH is often misdiagnosed because its symptoms overlap significantly with other common age-related conditions, such as Parkinson's and Alzheimer's disease. This confusion can lead to missed opportunities for effective treatment.

Is early diagnosis critical for NPH?

Yes, early diagnosis is critical. The chances of reversing symptoms and achieving a positive outcome with treatment are highest when NPH is diagnosed and treated in its early stages.

What is the primary treatment for NPH?

The primary treatment for NPH is the surgical insertion of a shunt. This device is designed to drain excess cerebrospinal fluid (CSF) from the brain, relieving the pressure and often reversing the symptoms.