Normal pressure hydrocephalus mimicking Alzheimer's disease: such an infrequent case?

Normal pressure hydrocephalus (NPH) is an age-related condition frequently associated with degenerative and vascular brain pathologies. However, cases of NPH with no concomitant brain pathology have been described with important implications in terms of early detection and treatment. We present a case of NPH that commenced with cognitive deterioration similar to Alzheimer's disease (AD). Motor manifestations (i.e., falls and gait dysfunction) appeared 2.5 years after the initiation of memory problems. Apart from ventricular enlarging, no prominent pathologies were found at brain examination. The prevalence of cases of NPH presenting with memory problems may be underestimated given the traditional view of NPH displaying a clinical triad of gait dysfunction, mental decline of "subcortical" appearance, and incontinence. Careful examination of the structural neuroimaging study in the initial assessment and during follow-up could help in diagnosis. Further research on prevalence and detection of "pure" NPH initially resembling AD is warranted.