Editing Normal pressure hydrocephalus (section)

==Signs and symptoms==
NPH exhibits a classic triad of clinical findings (known as the Adams triad or [[Salomón Hakim|Hakim's]] triad). The triad consists of walking difficulty, reduced attention span, and urinary frequency or incontinence. Symptoms present insidiously over the course of 3–6 months.<ref name=":0" /> The triad is considered obsolete for diagnostic purposes and newer guidelines are available.<ref name=nakajima-2021 /><ref name=fasano-2021-UofT />

[[Gait abnormality|Gait deviations/balance problems]] are present in nearly all NPH patients and are typically the first presenting symptom. This is caused by expansion of the [[lateral ventricles]], which can impinge on the [[corticospinal tract]] motor fibers. The typical gait abnormality in NPH is a broad-based, slow, short-stepped, "stuck to the floor", or "magnetic" movement. The gait abnormalities in NPH may bear resemblance to a gait associated with [[Parkinson's disease]]. The gait deviation can be classified as mild, marked, or severe: "marked" is when the patient has difficulty walking because of considerable instability; "severe" is when it is not possible for the patient to walk without aids (such as a cane or a wheeled walker).<ref>{{cite book | vauthors = Krauss JK, Faist M, Schubert M, Borremans JJ, Lucking CH, Berger W | date = 2001 | chapter = Evaluation of Gait in Normal Pressure Hydrocephalus Before and After Shunting | veditors = Ruzicka E, Hallett M, Jankovic J | title = Gait Disorders | pages = 301–09 | location = Philadelphia, PA | publisher = Lippincott Williams & Wilkins }}</ref><ref name="adams">{{cite book | vauthors = Ropper AH, Samuels MA | date = 2009 | title = Adams and Victor's Principles of Neurology | edition = 9th | location = New York | publisher =  McGraw-Hill Medical }}</ref> An associated tremor of the hands, legs, or feet can be seen in up to 40% of NPH patients.<ref name=":4">{{Cite journal |last1=Shprecher |first1=David |last2=Schwalb |first2=Jason |last3=Kurlan |first3=Roger |date=September 2008 |title=Normal pressure hydrocephalus: diagnosis and treatment |journal=Current Neurology and Neuroscience Reports |volume=8 |issue=5 |pages=371–376 |doi=10.1007/s11910-008-0058-2 |issn=1534-6293 |pmc=2674287 |pmid=18713572}}</ref>

[[Dementia]] presents as progressive cognitive impairment which is present in 60% of patients at time of treatment. This is caused by distortions predominantly at the [[frontal lobe]] and the [[Cerebral cortex|subcortex]].<ref name="younger" /> Initial deficits involve planning, organization, attention, and concentration. Further deficits include difficulty managing finances, taking medications, driving, keeping track of appointments, daytime sleeping, short-term memory impairments, and psychomotor slowing. Late-stage features include apathy, reduced drive, slowed thinking, and reduced speech.

[[Urinary incontinence]] appears late in the illness and is present in 50% of patients at time of treatment. Urinary dysfunction begins as increased [[Urinary frequency|frequency]] often at night and progresses to [[urge incontinence]] and permanent incontinence.<ref name="younger" />