PSYCHIATRIC AND BEHAVIORAL MANIFESTATIONS OF NORMAL PRESSURE HYDROCEPHALUS

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Abstract
Normal pressure hydrocephalus (NPH) may suggest its presence by behavioral symptoms. Initially, the symptoms often manifest themselves as depression with marked psychomotor retardation. Older patients without a prior psychiatric history who have soft, nonlocalizing neurological signs and fluctuating cognitive and memory deficits in association with prominent affective and/or psychotic symptomatology of recent onset, such as the case reported here, should raise the clinican''s index of suspicion. In such cases, the Halstead-Reitan neuropsychological battery may be helpful in differentiating an underlying dementia from a primary psychological dysfunction. When the presence of a dementing process is suspected, etiological diagnosis should be vigorously pursued with a CAT [computerized axial tomography] scan and, as indicated on clinical grounds, confirmatory and further delimiting studies such as pneumoencephalography, ventriculography, RISA [radioiodinated serum albumin] scanning, EEG, constant-infusion manometric testing and/or angiography. Treatment of NPH includes 1 of several forms of shunting procedures and appropriate neuroleptic therapy for behavioral symptoms. Although there is a substantial risk (40-50%) of shunt-related complications, as many as 60% of operated patients may show objective improvement, making the diagnosis of and referral for appropriate surgical treatment of NPH an important challenge for the psychiatrist.

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