Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalus (NPH) is a treatable cause of walking problems, cognitive decline, and urinary symptoms in older adults. It occurs when cerebrospinal fluid (CSF) builds up in the brain’s ventricles, causing them to enlarge and disrupt nearby brain pathways. Despite the name, CSF pressure often measures within normal range.

At The Royal Buckinghamshire Hospital, we support adults living with the consequences of NPH—before and after medical or surgical treatment—through consultant-led inpatient neurorehabilitation aimed at improving mobility, confidence, and day-to-day independence.

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Key Symptoms

NPH is classically associated with a triad of symptoms:

• Gait Disturbance: slow, broad-based, shuffling steps; difficulty initiating gait; poor balance and frequent falls.
• Cognitive Changes: slowed thinking, inattention, planning and memory difficulties (often milder than Alzheimer’s at onset).
• Urinary Symptoms: urgency, frequency, or incontinence.

Symptoms may progress gradually and are often mistaken for Parkinson’s disease or Alzheimer’s disease. Unlike those conditions, NPH can improve with the right intervention and rehabilitation.

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Causes And Risk Factors

• Idiopathic (most common): develops without a clear trigger, typically in later life.
• Secondary NPH: following subarachnoid haemorrhage, meningitis/encephalitis, head injury, or neurosurgery.

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Diagnosis

Diagnosis is made by a specialist team using history, examination and investigations such as:

• Brain MRI or CT to show enlarged ventricles out of keeping with cortical atrophy.
• CSF tests (e.g., large-volume lumbar puncture or external lumbar drainage) to assess for gait or cognitive improvement after CSF removal.
• Neuropsychological evaluation to profile cognitive changes and guide therapy.

Some patients are considered for CSF shunt surgery (e.g., ventriculo-peritoneal shunt) by neurosurgical teams. We do not perform neurosurgery onsite but provide rehabilitation support before and after intervention, with onward referral where needed.

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Rehabilitation At The Royal Buckinghamshire Hospital

Whether you are awaiting decisions about treatment or recovering after a CSF diversion procedure, our inpatient neurorehabilitation programmes target the areas most affected by NPH.

Your Programme May Include

• Neurophysiotherapy: gait initiation and cueing strategies, step length and turning practice, balance and falls-prevention, strengthening and endurance.
• Occupational Therapy: energy conservation and pacing, transfers and personal care, home-safety review, equipment and adaptations, routines to support memory and planning.
• Neuropsychology: strategies for attention, memory and executive function; mood and adjustment support; carer education.
• Speech And Language Therapy (as required): communication strategies, cognitive-communication training, swallowing assessment where indicated.
• Education & Self-Management: personalised home exercise plans, falls plans, and community therapy handover.

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When To Consider Inpatient Rehab

• Worsening gait instability or recurrent falls.
• Persistent freezing of gait or difficulty initiating steps.
• Cognitive changes impacting daily life despite outpatient input.
• Need for co-ordinated, multidisciplinary therapy and carer training.
• Post-operative recovery after shunt insertion with residual mobility or cognitive issues.

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Living Well With NPH

• Maintain a structured activity plan with rests to manage fatigue.
• Use external cues (visual floor markers, rhythmic counting) to assist step initiation and turning.
• Review footwear and home hazards; consider grab rails and seating.
• Keep a medication and appointments diary; involve family/carers in strategy practice.
• Optimise vascular risk factors (blood pressure, diabetes, cholesterol) which can compound gait and cognitive problems.