DALLAS, Feb. 14, 2026 — At 66, Richard “Dick” Nash discovered something was seriously wrong during a two-mile walk for juvenile diabetes, a fundraiser for his granddaughter. “It wasn’t a big deal distance-wise, but I couldn’t finish without falling,” he recalls. “My wife had to help me back to the car.”
A rare brain condition, normal pressure hydrocephalus (NPH), often misdiagnosed as Parkinson’s disease, affects an estimated 1 to 2 million Americans.
- Normal pressure hydrocephalus (NPH) involves excess fluid in the brain, causing mobility, cognitive, and urinary issues.
- NPH is often mistaken for Parkinson’s disease, leading to delayed or incorrect treatment.
- A specialized diagnostic approach, including lumbar infusion tests, is crucial for accurate NPH identification.
- Surgical intervention, like shunt placement, can significantly improve quality of life for NPH patients.
That walk in 2011 marked the beginning of a decade-long health decline. Dick’s legs grew stiff, his balance faltered, and walking became increasingly difficult. His movements slowed, and even concentration proved challenging, hindering everyday conversations. By 2016, a neurologist diagnosed him with Parkinson’s disease, a progressive disorder with no known cure.
What is Normal Pressure Hydrocephalus?
Typically diagnosed in people over 60, normal pressure hydrocephalus (NPH) occurs when cerebrospinal fluid (CSF) builds up in the brain. Healthy brains constantly create, circulate, and reabsorb CSF. When this process is disrupted, excess fluid compresses the brain, impairing its natural cleaning functions. This can lead to progressive difficulties with walking, thinking, and bladder control.
A: Unlike typical hydrocephalus, NPH doesn’t usually involve increased pressure within the brain, making it harder to detect through standard tests.
Unlike typical hydrocephalus, where patients have significantly increased brain pressure, those with NPH often show little or no pressure increase, complicating diagnosis. Recent international studies suggest NPH affects 1.5% to 3% of individuals aged 70–77, and over 6% of those 80 and older—a prevalence considerably higher than Parkinson’s disease. Yet, only 20% to 40% of those affected ever receive a diagnosis and treatment.
Types of Normal Pressure Hydrocephalus
NPH is generally categorized into two types:
- Idiopathic NPH, where the cause is unknown, often linked to age-related disruptions in CSF circulation.
- Secondary NPH, resulting from another medical condition, such as:
- Head injury
- Surgery complications
- Subarachnoid hemorrhage (bleeding around the brain)
- Brain tumors
- Brain infections (like meningitis)
- Brain inflammation
The condition gained rare public attention in May 2025 when musician Billy Joel revealed his own diagnosis and began treatment.
The Search for Effective Treatment
Despite physical therapy and medication, Dick’s Parkinson’s symptoms persisted and worsened. He became largely homebound, relying on a wheelchair for outings. Cognitive decline made conversations and basic tasks difficult, taking a toll on his wife of over 55 years, Sharon Nash. “He had basically given up,” Sharon said. “He didn’t want to live. He didn’t want to do anything, so his muscles had atrophied.”
A breakthrough came during a routine physical therapy appointment at UT Southwestern to address incontinence. Pelvic floor specialist Michelle Bradley, PT, DPT, WCS, initially accepted Dick’s Parkinson’s diagnosis. However, after he arrived in a wheelchair following a procedure involving valium, she suspected something else. “Knowing valium does not cause such a quick and long-lasting decline, I was concerned,” she said.
Concerned by the rapid deterioration, Bradley immediately requested a neurology consultation.
The First Steps to an NPH Diagnosis
Dick first met with Vibhash Sharma, M.D., Medical Director of the Interventional (Neuromodulation) Movement Disorders Clinic at UT Southwestern. Dr. Sharma ruled out Parkinson’s, noting Dick hadn’t developed other typical symptoms and hadn’t responded to levodopa, a medication used to treat Parkinson’s. A previous DaT scan also showed limited evidence of the disease.
Based on a new MRI scan, Dr. Sharma referred Dick to the NPH team at UT Southwestern.
The Right Team for the Right Diagnosis
In February 2024, Dick met with UT Southwestern’s dedicated NPH team, including Padraig O’Suilleabhain, M.D., a neurologist specializing in movement disorders, and Jeffrey Schaffert, Ph.D., a clinical neuropsychologist specializing in dementia syndromes. The team wasn’t surprised by the previous Parkinson’s diagnosis, but further evaluation revealed mounting evidence of NPH.
Clinical Symptoms
Doctors observed Dick’s “magnetic gait,” where his feet seemed to stick to the ground. Dr. O’Suilleabhain explained this is a classic symptom that had worsened over a decade. Dr. Schaffert noted the lack of response to levodopa and a negative DaT scan raised concerns. “The fact that he didn’t get better raises a yellow flag of ‘what else could we be dealing with?’”
Fluctuating symptoms also pointed toward NPH. “Parkinson’s symptoms can change in severity as neurons are lost, but the variation in CSF outflow that NPH causes produces a similar effect,” Dr. O’Suilleabhain said.
Imaging
Brain scans revealed enlarged ventricles, likely due to excess CSF and reduced outflow, disrupting communication between the brain and legs. Disproportionately enlarged grooves in the brain, resembling shrinkage, may have contributed to the initial misdiagnosis.
CSF Drains
Two previous lumbar spinal taps hadn’t provided conclusive results. However, during a recent hospital stay, doctors performed a lumbar infusion test, which uses real-time sensors to monitor intracranial pressure and assess CSF flow. Dick’s ICP became elevated during the infusion and took a significant amount of time to lower.
The NPH Diagnosis Gap
Misdiagnosis is common with NPH. Unlike cognitive conditions with specific markers, NPH lacks a definitive test. Patients often undergo CSF testing, lumbar drains, medication, and potentially surgery before receiving a correct diagnosis.
Recent research, including a Swedish study of nearly 800 70-year-olds, found 1.5% with evidence of NPH, and an earlier study revealed a significantly higher prevalence among those over 80. This has prompted specialists at UT Southwestern to form a dedicated interdisciplinary team.
One Last Test to Confirm NPH
The NPH team recommended a final CSF drain and a lumbar infusion test. Dick was admitted to William P. Clements Jr. University Hospital, where a lumbar drain was placed for four days, removing CSF to reset the brain’s fluid systems. While he reported some improvement, the results weren’t definitive. However, the lumbar infusion test revealed elevated ICP and slow CSF absorption, providing enough evidence to diagnose NPH and recommend a shunt.
Relieving the Brain Pressure
On Aug. 1, 2024, Dick underwent surgery at Clements University Hospital. He viewed it as his last chance. A ventriculoperitoneal shunt was installed to drain excess CSF from his brain to his abdomen, relieving pressure and restoring the brain’s waste removal system.
From NPH to Rebirth
Unlike many NPH patients, Dick experienced almost immediate improvement. Just one day after surgery, he walked 250 steps with a walker. “It was the furthest I’d walked in six months,” he said. Describing the surgery as his “day of rebirth,” Dick now walks about three miles daily and has regained much of his lost functionality. At 80, he’s more active than he was almost a decade ago. “I can operate in the kitchen now,” he said. “I can go out when people invite me to leave the house.”
He’s also resumed socializing and reduced his medication by 60%. Most importantly, he’s spending quality time with his great-grandsons. “Dr. Schaffert, Dr. White, and Dr. O’Suilleabhain are heroes because they did what was necessary,” Dick said. “They listened to me.”
Dick hopes his experience will raise awareness of NPH, leading to earlier diagnosis and treatment for others. “Miracles do happen,” he said. “And I was the beneficiary of a miracle.”
