Normal pressure hydrocephalus is a treatable cause of gait disturbance in older adults. The classic triad is a slow, wide-based or magnetic gait, cognitive slowing and urinary urgency, though not all three are present at first. Gait is usually the earliest and most prominent feature.
When an older patient presents with falls and slowed walking, ask about urinary symptoms and memory, look at gait directly, and consider brain imaging for enlarged ventricles out of proportion to atrophy. Early recognition matters because gait is the feature most likely to respond to treatment.
- Watch the patient walk; do not rely on history alone.
- Ask about urinary urgency and cognitive change.
- Request brain imaging when gait slowing is unexplained.
- Refer to neurology or neurosurgery when imaging suggests hydrocephalus.
Why it matters
Gait disorder is a treatable presentation that is easily attributed to ageing.
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