Alberto J. Espay, MD, MSC, FAAN, responds:

Normal pressure hydrocephalus (NPH), which is a syndrome, is no reason to limit exercise—as long as it's done safely. Many people with this diagnosis are at risk for falls and require supervision, even for activities with low impact.

Why Exercise Is Important

The benefits of exercise for anyone, including people with NPH, go beyond the physical. Exercise is often accompanied by music, and it can be a chance to get outside and to socialize with others, all of which are good for people with NPH. Slow, gentle exercises such as tai chi, chair yoga, and water exercise are less likely to cause falls and injuries. Exercise bikes and elliptical machines are also good options, as are activities that allow you to grab bars or handles to reduce the risk of falling. Walking is also a good activity, even with a walker. People who don't need a walker or cane should still walk with a companion.

Defining Normal Pressure Hydrocephalus

NPH is an abnormal buildup of cerebrospinal fluid (CSF) in the ventricles, the fluid-filled cavities in the brain. It can cause mental impairment and dementia, difficulty walking, and loss of bladder control. It's called normal pressure hydrocephalus because when the CSF pressure is measured during a lumbar puncture, it's often normal.

The syndrome primarily affects people over the age of 65 and often goes undiagnosed because its symptoms can be similar to those in other brain disorders such as Alzheimer's disease and Lewy body dementia. In addition, Alzheimer's disease and Lewy body dementia can present with hydrocephalus and be misdiagnosed as NPH. Finally, there is a category of secondary NPH brought on by a brain hemorrhage, head injury, infection, tumor, or complications of surgery. In many cases, however, the cause is unknown at the outset.

Diagnosing Normal Pressure Hydrocephalus

To diagnose NPH, a doctor will search for other causes of the symptoms. If none are found, the doctor may perform additional procedures such as a type of lumbar puncture that draws a larger amount of CSF or temporarily inserting a catheter in the spine to drain CSF externally to see if removing more fluid improves the patient's balance or gait as measured before and after the procedure. Responses to these tests help doctors identify patients who are eligible for surgery.

Treating Normal Pressure Hydrocephalus

Eligible patients may undergo shunt surgery, which involves inserting a long, thin tube that drains excess CSF from the brain to the abdomen, allowing the ventricles to return to normal. Difficulty walking is the symptom most likely to improve after surgery, which can make exercise easier.

Talk to Your Doctor About Exercise

Because of the risk of falling, it's important to discuss exercise options with your neurologist and to have someone spot you during any activity. Talk to your doctor about the appropriate type and amount of exercise for you. Together, you can pick the activity best suited to your walking and balance abilities and your overall health and cardiovascular fitness. In general, patients with shunts should avoid sit-ups and crunches and wear a helmet for any activity that can lead to a fall or head injury, such as cycling.

For more about exercising with a neurologic disorder, visit BrainLifeMag.org/ExerciseAndYou.