Normal Pressure Hydrocephalus (NPH) Evaluation & Management Program

Overview

Normal Pressure Hydrocephalus (NPH) is a neurological disorder of older adults that is increasing in prevalence and yet often unrecognized. Its symptoms include insidious and progressive difficulties with walking, memory and thinking, and bladder control. With a head CT scan or MRI, enlarged ventricles in the brain are seen. NPH can be a difficult diagnosis to make because its symptoms overlap with those of other common conditions such as Parkinsonism, Alzheimer’s disease and age-related osteoarthritis and bladder dysfunction. However, it is critical to diagnose NPH if present because it is one of the few dementing conditions that can be controlled or reversed with ventricular shunting.

At Massachusetts General Hospital, our mission is to provide state-of-the-science diagnosis, treatment and management for patients with NPH. Our program also serves as a base for clinical research to monitor and optimize outcomes, improve methods for diagnosis, evaluate new therapies and theranostics and increase knowledge about NPH.

An initial visit at the NPH Program consists of a comprehensive history and neurological and cognitive exams by a neurology physician and nurse team. Based on the initial impressions, additional diagnostic testing may be recommended including neuroimaging with MRI or PET and cerebrospinal fluid testing. If these tests support a diagnosis of NPH, then surgical treatment with a shunt to normalize cerebrospinal fluid flow may be recommended. Follow-up care and ongoing management of the condition is available.

Frequently Asked Questions

What happens in a new patient appointment and what can I expect?

A new patient’s initial clinic appointment will take about 75 minutes and will consist of reviewing a patient’s medical, neurologic and neuropsychiatric histories, clinical examination, discussion and counseling of the patient’s and family members’ concerns, and development of a follow-up treatment plan. Our clinicians may also order more in-depth tests for the patient that includes blood draws, neuroimaging scans (e.g., PET, MRI, etc.), neuropsychological tests or lumbar puncture procedures.

Will I have testing the same day as my appointment?

We do a comprehensive evaluation before your visit. We will intensively screen your record and triage appropriately for a broad evaluation or a more focused visit. It is possible that you will have some testing on the same day of the appointment. We will let you know beforehand.

Why does someone have to accompany me and why can’t I come alone?

Since our patients have memory problems or other cognitive concerns, we require our patients to come to their clinic appointments with a close family member or an individual who can provide reliable information about their medical condition.

How often will I have appointments?

After the first appointment, our clinicians may order additional tests and a follow-up visit (known as a résumé visit) to review test results will be scheduled. After the résumé visit, most patients will be seen about every 6 months for follow-up visits.

Should I bring anything?

If available, please bring any pertinent medical records, neuroimaging scans, and an updated list of current medications.

How long are the appointments?

New patients’ initial visits: about 75 minutes
Résumé visits: about 30 minutes
Follow up visits: about 45 minutes