Normal Pressure HydrocephalusPhoenix, AZ
Wet. Wobbly. Weird. It Might Not Be Dementia, and It Might Be Treatable. Normal Pressure Hydrocephalus (NPH) is one of the few causes of memory loss and decline in older adults that can often be reversed. Dr. Randall Porter, a 13-time Phoenix Magazine Top Doctor, diagnoses and treats NPH in Phoenix, Arizona.
The Three Signs Every Family Should Know
Doctors remember NPH by three hallmark symptoms often called "Wet, Wobbly, and Weird.” If someone you love has two or all three of these, it's worth getting evaluated:
WET — Bladder Problems
- Sudden, urgent need to urinate
- Accidents or incontinence
- Frequent nighttime urination
WOBBLY — Trouble Walking
- Shuffling steps, as if the feet are “stuck to the floor”
- Poor balance, unsteadiness, frequent falls
- Difficulty starting to walk or turning around
- *This is often the first symptom to appear*
WEIRD — Thinking Changes
- Forgetfulness and short-term memory loss
- Slowed thinking or difficulty concentrating
- Apathy, loss of interest, personality changes
Not every patient has all three. Walking problems usually come first, and thinking changes are often milder than in Alzheimer's disease.
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What Is Normal Pressure Hydrocephalus?
Your brain is bathed in cerebrospinal fluid (CSF), a clear fluid that cushions and nourishes it. Normally, your body makes and reabsorbs this fluid in perfect balance. In NPH, that balance is lost. Fluid slowly builds up inside the brain's ventricles, enlarging them and pressing on the brain tissue that controls walking, bladder function, and memory.
Because the pressure rises slowly, symptoms creep in gradually, which is why NPH is so often mistaken for "normal aging," Alzheimer's disease, or Parkinson's disease.
Key facts:
- NPH primarily affects adults over 60
- Studies suggest a meaningful percentage of patients diagnosed with dementia may actually have NPH
- Unlike most causes of dementia, **NPH is treatable** — and treatment often improves symptoms significantly
Why NPH Is So Often Missed
NPH looks like the conditions doctors see far more often:
| Symptom | Often Mistaken For |
- | Memory decline | Alzheimer’s disease / dementia |
- | Shuffling gait | Parkinson’s disease |
- | Incontinence | “Just part of getting older” |
- | Slowed thinking | Depression or normal aging |
The tragedy is that families accept a dementia diagnosis and give up hope when the real problem was fluid on the brain that could have been treated.
If your loved one has been diagnosed with dementia or Parkinson's but also has walking problems and bladder symptoms, ask about NPH.
Getting a Clear Answer
Diagnosing NPH is straightforward when you know what to look for:
- Clinical evaluation — Dr. Porter reviews symptoms, medical history, and performs a neurological exam, paying close attention to gait.
- Brain imaging (MRI or CT) — enlarged ventricles are the visual hallmark of NPH.
- High-volume lumbar puncture (“spinal tap test”) — a controlled amount of spinal fluid is removed. If walking and thinking improve afterward — often within hours — it strongly predicts that treatment will help. Family members are frequently amazed at the difference.
Treatment: The VP Shunt
The standard treatment for NPH is a ventriculoperitoneal (VP) shunt — a thin, soft tube placed during a short surgical procedure that drains excess fluid from the brain to the abdomen, where the body harmlessly reabsorbs it. Modern shunts are programmable, so the drainage rate can be adjusted in the office without additional surgery.
What improvement can look like:
- Walking is typically the first and most dramatic improvement
- Bladder control often improves
- Memory and thinking may improve, especially when treated early
Why Timing Matters: The longer NPH goes untreated, the more difficult symptoms are to reverse. Early evaluation gives the best chance of meaningful recovery.
Individual results vary. A thorough evaluation determines whether shunt surgery is likely to help in each specific case.
Experience You Can Trust With Your Parent’s Brain
- Team Neurosurgeon, Arizona Cardinals
- Voted Top Doctor by his physician peers in Phoenix Magazine 13 times
- Over 100 published articles and honored as *Teacher of the Year*
- A career of Arizona surgical firsts, including the state’s first CyberKnife procedure, first XLIF, and first endoscopic microvascular decompression
When it comes to your loved one's brain, choose the neurosurgeon other doctors choose.
Frequently Asked Questions
Q. Is NPH the same as dementia?
A. No. NPH can cause dementia-like symptoms, but unlike Alzheimer's disease, it is often treatable — and symptoms can improve after treatment.
Q. My mother was already diagnosed with Alzheimer's. Could it still be NPH?
A. Possibly. NPH is frequently misdiagnosed as Alzheimer's or Parkinson's. If walking problems and bladder symptoms are present alongside memory decline, an NPH evaluation is worthwhile. Some patients have both conditions.
Q. What does the "spinal tap test" feel like?
A. It's similar to an epidural. Fluid is removed through a small needle in the lower back, and walking is tested before and after. Improvement afterward suggests a shunt is likely to help.
Q. Is shunt surgery dangerous for an elderly patient?
A. All surgery carries risk, but shunt placement is a short, common procedure that many patients in their 70s and 80s tolerate well. Dr. Porter will discuss individual risks and benefits at your consultation.
Q. Does insurance cover NPH treatment?
A. NPH diagnosis and treatment, including shunt surgery, are generally covered by Medicare and most insurance plans when medically indicated. Our office can help verify your coverage.
Don’t Assume It’s “Just Aging.
If someone you love is “Wet, Wobbly, and Weird” — struggling with bladder control, balance, and memory — get answers. An evaluation could change the rest of their life.
Randall Porter, M.D. is located at 2910 N 3rd Ave Ste A Phoenix, AZ 85013.
Call us At (602) 603-8951
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