Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus

Vincent Vacca, MSN RN CCRN

Disclosures

J Neurosci Nurs. 2007;39(2):107-111. 

In This Article

Abstract and Introduction

Idiopathic normal pressure hydrocephalus (INPH) is characterized by a classic triad of symptoms including dementia, urinary incontinence, and gait disturbance. INPH is clinically diagnosed in most patients during the sixth or seventh decade of life. Many older adults are incorrectly diagnosed with disorders such as Parkinson's disease and dementia when their symptoms are actually caused by INPH. As life expectancy increases, the necessity of accurately diagnosing and effectively treating these affected individuals will become more challenging. The diagnosis of INPH is challenging and requires a combination of clinical signs and symptoms, radiographic findings, and diagnostic testing. The purpose of evaluation and testing of individuals with suspected INPH is to determine if surgical implantation of a ventriculoperitoneal (VP) shunt will be beneficial. VP shunting is now a common neurosurgical procedure, but it is one associated with risks and complications, which makes evaluation of "shunt-responsiveness" essential.

First described by Hakim and Adams in 1965, idiopathic normal pressure hydrocephalus (INPH) is an enlargement of cerebral ventricles (Fig 1) without evidence of chronic increased intracranial pressure (ICP). INPH is associated with a triad of symptoms including gait disturbance, dementia, and urinary incontinence (Relkin, Marmarou, Klinge, Bergsneider, & Black, 2005).

Hydrocephalus from INPH

In 2000, the costs of treating INPH exceeded $1 billion. There were 27,870 patients with INPH treated that year, and more than 8,000 new cases diagnosed (Fife, 2003). According to the U.S. Census Bureau, in 2002 there were nearly 60 million people aged 55 years or older living in the United States. Average life expectancy was 77.2 years in 2001, according to the National Center for Health Statistics, Centers for Disease Control and Prevention. Average life expectancy is expected to continue to increase (CDC, 2003).

As people live well into their seventh decade and beyond, both the number of diagnosed cases of INPH and the associated treatment costs will increase. Understanding the symptoms, workup, diagnosis, and treatment of INPH is very important as this condition develops into a major public health issue. This article reviews INPH as a national healthcare issue and presents a case study.

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