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.
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:
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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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 looks like the conditions doctors see far more often:
| Symptom | Often Mistaken For |
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.
Diagnosing NPH is straightforward when you know what to look for:
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.
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.
When it comes to your loved one's brain, choose the neurosurgeon other doctors choose.
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.
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