Normal Pressure Hydrocephalus is one of the few causes of dementia-like symptoms that may be treatable. Mr Sikander is an internationally recognised NPH specialist offering expert assessment at leading private facilities in London and via video consultation across the UK.
Specialist NPH assessment and treatment by a consultant neurosurgeon.
Normal Pressure Hydrocephalus develops gradually. The symptoms often appear over months or years and are frequently attributed to normal ageing. Families are usually the first to notice changes, particularly in the way a parent or relative walks, thinks and manages daily life.
NPH produces a characteristic combination of three symptoms, often referred to as the classic triad. Recognising this pattern is an important first step toward diagnosis.
These three symptoms appearing together, particularly in someone over 60, should prompt specialist assessment. Not all three need to be present at once – gait problems alone may be an early sign of NPH and should not be dismissed as simply getting older.
You may wish to seek specialist advice if you or a family member are experiencing any of the following. Recognising these as potential signs of a treatable condition can allow for earlier diagnosis and a better outcome.
NHS guidance confirms that NPH can be difficult to diagnose because its symptoms develop gradually and closely resemble more common conditions such as Alzheimer’s disease. Because the symptoms overlap, NPH can sometimes be mistaken for dementia or attributed to normal ageing.
Unlike most forms of dementia, NPH may respond to treatment. When correctly identified, symptoms of walking difficulty, cognitive decline and bladder problems can often be significantly improved through a relatively straightforward surgical procedure.
Cambridge University Hospitals recently highlighted that “NPH is frequently missed or mistaken for untreatable forms of dementia like Alzheimer’s disease”. Treatment for NPH is gaining global interest.
In NPH, walking problems typically appear early and are prominent. Memory difficulties tend to involve slowed thinking rather than the disorientation seen in Alzheimer’s. Bladder symptoms are common in NPH but less typical in early dementia. A specialist assessment can distinguish between the two.
Diagnosing NPH requires specialist assessment. There is no single test that confirms the condition, so diagnosis involves a structured combination of clinical evaluation, imaging and, where appropriate, further testing to assess whether treatment is likely to be effective.
For patients with confirmed NPH who are suitable candidates, treatment can significantly improve symptoms and quality of life. The most established treatment is ventriculoperitoneal shunt surgery, a procedure Mr Sikander performs regularly.
The goal of treatment is to improve symptoms, restore independence and enhance quality of life. Not every patient with NPH will benefit from surgery, and careful assessment is essential to identify those most likely to respond well.
Ventriculoperitoneal (VP) shunt surgery is the standard treatment for NPH. A thin tube is placed to redirect excess cerebrospinal fluid from the brain’s ventricles to the abdomen, where it is safely absorbed. Modern programmable shunts allow the drainage rate to be adjusted after surgery without further procedures, with a short-stay surgical treatment pathway.
Not everyone diagnosed with NPH will benefit from shunt surgery. Careful pre-operative assessment, including response to lumbar drainage testing, helps identify patients most likely to see meaningful improvement. This balanced approach ensures patients and families have realistic expectations.
After shunt surgery, regular follow-up is essential to monitor improvement, check shunt function and adjust settings if needed. Patients are supported throughout their recovery with structured review appointments.
Mr Sikander has extensive experience in the diagnosis and surgical treatment of Normal Pressure Hydrocephalus. His expertise is recognised internationally, and he accepts referrals from across the UK and overseas.
Many patients referred to Mr Sikander have previously been told their symptoms are due to dementia or normal ageing. His particular focus on NPH means he is experienced in identifying this condition where others may have overlooked it.
Oxford Neurospine offers video consultations for patients outside London or those who prefer an initial remote assessment. This makes specialist NPH evaluation accessible to patients across the UK and internationally.
If you are worried about walking problems, memory changes or bladder symptoms in yourself or a family member, specialist assessment is available promptly. Oxford Neurospine offers private NPH assessment in London and video consultations for patients elsewhere in the UK and internationally. No GP referral is required.
Expert answers to the questions most commonly asked by patients and families about NPH symptoms, diagnosis and treatment options.
The first symptoms of Normal Pressure Hydrocephalus (NPH) often involve changes in walking and balance. A person may begin taking shorter, slower steps, feel unsteady, shuffle their feet or find it more difficult to turn.
Other symptoms can include changes in memory and thinking, reduced concentration and increasing problems with bladder control. Symptoms often develop gradually and may initially be mistaken for normal ageing or another neurological condition.
If changes in walking occur alongside cognitive or bladder symptoms, a specialist assessment can help determine whether NPH may be a possible cause.
Yes. Normal Pressure Hydrocephalus can be mistaken for dementia because it can cause memory problems, slower thinking and changes in behaviour or concentration.
NPH may also cause distinctive problems with walking and bladder control. These symptoms, together with brain imaging and specialist assessment, can help distinguish NPH from conditions such as Alzheimer's disease.
Getting the correct diagnosis is particularly important because some symptoms of NPH may improve with appropriate treatment.
Normal Pressure Hydrocephalus is diagnosed through a combination of symptoms, clinical assessment and brain imaging rather than a single test.
Assessment may include evaluating walking and balance, memory and thinking, bladder symptoms and MRI or CT scans of the brain. Further investigations, such as a lumbar puncture, lumbar drainage test or lumbar infusion test, may be recommended to assess cerebrospinal fluid (CSF) and whether a patient could benefit from treatment.
The exact investigations required will depend on the individual patient and their symptoms.
Yes. Normal Pressure Hydrocephalus can be treated, and for suitable patients the main treatment is surgery to divert excess cerebrospinal fluid (CSF) away from the brain using a shunt.
Treatment aims to improve symptoms such as difficulty walking, cognitive changes and bladder problems. Not everyone with suspected NPH will be suitable for shunt surgery, so specialist assessment and appropriate investigations are important before treatment is recommended.
An NPH shunt is a medical device used to drain excess cerebrospinal fluid (CSF) from the brain in patients with Normal Pressure Hydrocephalus.
The shunt consists of thin tubing and a valve that controls the drainage of CSF. It redirects the fluid to another part of the body where it can be absorbed. Shunt surgery can improve symptoms of NPH in appropriately selected patients, particularly problems with walking and mobility.
Suitability for NPH shunt surgery is assessed individually. A specialist will consider the patient's symptoms, brain imaging, general health and the results of any additional investigations.
Tests such as a lumbar puncture, CSF drainage test or other cerebrospinal fluid investigations may be used to help assess whether symptoms are likely to improve following shunt surgery.
Age alone does not necessarily determine whether someone is suitable for treatment. The potential benefits and risks of surgery need to be considered for each patient.
Many appropriately selected patients with Normal Pressure Hydrocephalus experience an improvement following shunt surgery, particularly in walking and mobility. Improvements in cognitive and bladder symptoms can also occur, although results vary between individuals.
Published NPH shunt success rates vary depending on how patients are selected, how improvement is measured and the length of follow-up. For this reason, it is more helpful to assess an individual’s likelihood of benefiting from surgery than to give a single success-rate figure.
A specialist NPH assessment can help determine whether shunt surgery may be appropriate and allow the potential benefits and risks to be discussed.
Normal Pressure Hydrocephalus usually develops gradually, although the rate at which symptoms progress can vary considerably between patients.
Walking and balance problems may become increasingly noticeable, while changes in memory, thinking and bladder control can develop alongside them. Because these symptoms can also occur with other neurological conditions or ageing, NPH can sometimes go unrecognised.
Anyone experiencing a combination of progressive walking difficulties, cognitive changes or bladder problems should seek medical assessment rather than assuming the symptoms are simply part of ageing.
No. You do not need a GP referral to arrange a private consultation with Mr Murtuza Sikander for suspected Normal Pressure Hydrocephalus (NPH).
Patients and their families can contact Oxford Neurospine directly to arrange an appointment. If you already have MRI or CT scans, clinic letters or details of previous investigations, these may be helpful for your consultation.
Private consultations are available in Harrow, London, with video consultations also available for patients elsewhere in the UK and internationally.
Helpful information on spinal and neurological conditions, treatment options and recovery.
If you would like to arrange a consultation or refer a patient, please get in touch. Oxford Neurospine provides expert care in Harrow, Northwood and London with a focus on clear communication, accurate diagnosis and effective treatment.
