When It’s Not Alzheimer’s: Understanding the Difference Between Alzheimer’s Disease and Normal Pressure Hydrocephalus (NPH)

When my 81-year-old bubbly and talkative grandmother suddenly slipped into a state of confusion, unresponsiveness, and repetitive speech, we were terrified. Doctors told us—multiple times, across several visits—that it was late-stage Alzheimer’s.

But something about that diagnosis didn’t sit right.

Just weeks earlier, we were sitting together on Christmas Eve—laughing, sipping prosecco, reminiscing. How could a disease that’s known to progress slowly take hold so fast?

She’d swing between extremes—moments of complete delirium where she couldn’t recognize colors, her surroundings, or even her own family, followed by moments of lucidity. She’d ask about the weather. She’d laugh at our jokes. She knew who we were.

The decline wasn’t consistent. It was abrupt. Erratic. Alarming. And deep down, I knew: This wasn’t Alzheimer’s.

And I was right.

My mom, aunt, and I threw ourselves into research—challenging doctors, asking questions, refusing to be dismissed. It was heartbreaking watching someone we love be written off as “too far gone.” After nearly a week of pleading, we convinced the neurology team to perform a large-volume CSF drainage—a test I had uncovered in my research that could reveal whether her symptoms were caused by fluid buildup, and therefore be NPH.

The result brought tears to my eyes.

After the procedure, she opened her eyes and said, “Oh my God, I feel great. I can finally recognize faces again.” That clarity lasted about eight hours. My family gathered around her bedside, soaking in every moment. She was present. She was her.

That’s when we knew. It was Normal Pressure Hydrocephalus (NPH)—a condition that mimics dementia, but one that’s treatable.

After brain shunt surgery, my grandmother began returning to herself. She talked. She walked. She laughed. And we got her back.

That experience changed everything for me. And it’s exactly why I’m here—sharing what we learned, so other families can fight for the answers they deserve.

What Is NPH?

Normal Pressure Hydrocephalus is caused by a buildup of cerebrospinal fluid (CSF) in the brain’s ventricles. The fluid puts pressure on surrounding brain tissue, leading to symptoms that closely resemble Alzheimer’s or Parkinson’s.

It’s most common in adults over 60, and wildly underdiagnosed—especially because the symptoms overlap so closely with dementia.

The “Classic Triad” of NPH Symptoms:

• Gait Disturbance – Shuffling, unsteady walking, or frequent falls

• Urinary Incontinence – Sudden urges or frequent accidents

• Cognitive Decline – Memory issues, confusion, or disorientation

Unlike Alzheimer’s, NPH can come on quickly, and here’s the game-changer: It’s treatable—often with a shunt procedure that drains the excess fluid from the brain.

Feature	NPH	Alzheimer’s
Onset	Sudden or gradual	Slow, progressive decline
Gait Issues	Early & obvious	Late-stage only
Incontinence	Common & early	Typically late-stage
Cognitive Fluctuation	Lucid moments	Steady decline
Response to CSF Drainage	Often dramatic	No response
Brain Imaging	Enlarged ventricles	General brain shrinkage

When to Get a Second Opinion

If something feels off—trust that feeling. Here are signs it’s time to dig deeper:

• The mental changes happened suddenly or seem to come and go

• Your loved one improves after a spinal tap (CSF drainage)

• Gait and bladder issues are front and center

• You’re told “it’s just Alzheimer’s,” but your gut says otherwise

Push for a neurology consult. Ask for an MRI. Request a spinal tap or a second opinion. NPH is real. It’s underdiagnosed. And it’s often reversible.

Advocate Like It Matters—Because It Does

We were told my grandmother was “too far gone,” and that surgery wasn’t worth it. But we kept pushing.

After her large-volume drainage, her improvement was so dramatic, the neurosurgeon changed his mind. She had the surgery—and today, she’s thriving. Her case is now being shared with medical teams as a reminder that not all dementia is Alzheimer’s.

If you’re watching someone you love slip away, and you’re being told “there’s nothing more we can do”—but your gut says something else?

Speak up. Ask questions. Get the scans. Get the tests.

You might just save a life.

Resources

• Hydrocephalus Association

• Cleveland Clinic on NPH

• Alzheimer’s Association

Written with love, persistence, and hope—for Grammy, and for every family navigating the unknown.