February 4, 2026

@michaelokun

Normal pressure hydrocephalus (NPH): Is this the comeback story of a treatable brain disorder? Normal pressure hydrocephalus refers to a condition where fluid builds up in the brain’s ventricles causing walking, thinking and bladder problems, even though pressure readings can look normal. Williams and colleagues describe in a new Viewpoint in JAMA Neurology how idiopathic normal pressure hydrocephalus has entered a new era driven by better evidence, improved patient selection and renewed engagement across care teams. Key Points: - Idiopathic normal pressure hydrocephalus is a distinct and treatable condition, not just a ‘mislabel’ for aging or dementia. - Randomized placebo-controlled trials show shunting can significantly improve gait and function in carefully selected folks. - Progress now depends on collaboration between specialty centers and community health care providers in order to identify the right patients for shunting. My take: This viewpoint reframes normal pressure hydrocephalus as a missed opportunity rather than a diagnosis to avoid. The science has matured, outcomes are better, and the biggest risk now may be failing to look for NPH. Here are 5 points that resonated w/ me: 1- Gait change is the most reliable and meaningful signal of improvement after shunting. 2- Careful patient selection using clinical guidelines is essential to balance the benefit and risk. 3- Many symptoms of normal pressure hydrocephalus overlap w/ aging and neurodegenerative disease which makes thoughtful evaluation critical. 4- Long term follow up and adjustable shunts matter as much as the surgery itself. 5- The future likely includes biomarkers and less invasive tools to help health care providers to identify the right folks earlier and to do it more confidently. https://jamanetwork.com/journals/jamaneurology/fullarticle/2844555 #michaelokun #fixelinstitute #parkinson #nph