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Ever since Billy Joel revealed on Instagram that he was suffering from normal pressure hydrocephalus (NPH), his condition has become big news, along with the surgical treatment that has eased his symptoms.��

With early diagnosis, a skilled neurosurgeon can provide the treatment capable of reversing its harmful effects; a neurosurgeon like Dr. Jared Knopman.����

Dr. Knopman wears multiple hats within 91�鶹��Ʒ. ���’s the Director of Cerebrovascular Surgery and Interventional Neuroradiology—a specialty involving the use of high-tech imaging to guide advanced surgical techniques for vascular disorders of the brain and spinal cord. ���’s also an Associate Professor of Neurological Surgery and Fellowship Director for Endovascular Neurosurgery.��

Keep reading for answers to your FAQs about a condition that affects from 3 to 5 percent of older adults but can be difficult to diagnose.����

What is NPH?��

NPH occurs when �ٳ�����’s a buildup of fluid in cavities, called ventricles, that lie deep within the brain. “N�ǰ�����������,” Dr. Knopman says, “cerebrospinal fluid bathes the brain and spinal cord, protecting them from injury and filtering the waste produced by brain metabolism. But when a patient has hydrocephalus, the brain’s plumbing gets clogged. As a result, �ٳ�����’s an imbalance between how much fluid is produced and how much gets absorbed into the bloodstream.”��

The build-up of too much fluid can damage brain tissues and cause what he calls a classic triad of symptoms.��

What are the characteristic symptoms of NPH?��

While NPH can occur in any age group, its symptoms in older adults typically follow a recognizable pattern, including:��

“Patients may have one, two or all three of these,” he says, “and they can easily be mistaken for other age-related issues.” ������’s why.��

Urinary incontinence is common among older people. ����’s often associated with an enlarged prostate, prostate cancer or weakening of the pelvic floor muscles—all conditions that become more prevalent as people age.����

The gait disturbance (abnormal walking) �ٳ󲹳�’s often seen in older people with NPH is characterized by a shuffling quality, and the patient’s feet tend to be spread wide apart as they walk, appearing to have a walk that looks “magnetic” to the floor. But such gait problems can also be caused by back or knee problems, which need to be ruled out before an NPH diagnosis can be confirmed, Dr. Knopman says.��

And third, cognitive decline, or dementia, is often associated with neurodegenerative diseases like Parkinson’s and Alzheimer’s. These, too, are fairly common among older adults.��

However, when all three of these classic symptoms are seen together, NPH is usually the culprit. An MRI will show the presence of excess fluid in the ventricles, thus suggesting a diagnosis of NPH.����

Do these symptoms appear suddenly or gradually?��

The symptoms of NPH tend to be progressive and slow-growing, he explains. “It can take several months, a year or even longer for them to become noticeable enough for a family member to bring their loved one in for diagnosis and treatment.”��