NPH questionnaires for initial evaluation

from The Neurologist 2010 Wilson et al.

Gait

1. Do you have a problem getting in or out of a seat, walking, or maintaining your balance?
2. How long has it been since you first had this problem?
3. Do you have a problem getting in and out of a car?
4. Do you have a problem starting to walk, as though your feet are stuck to the floor?
5. Do you shuffle or scuff your feet as you walk?
6. Do you have trouble turning?
7. Do you have trouble stepping over a curb or walking on an uneven surface such as grass?
8. Do you touch walls, surfaces or countertops when you walk?
9. In the past month, how often have you fallen?
10. Do you use a cane, walker or wheelchair?

Bladder

1. Do you urinate more frequently than you used to?
2. Do you lose a little urine before reaching the toilet?
3. Do you lose control of your bladder (incontinence)?
4. Do you wear a pad, undergarment or Depends for protection?

Cognition

1. Do you have trouble with your thinking or memory?
2. How long have you had the trouble?
3. Do you have trouble with forgetfulness (repeating questions, difficulty learning, short term memory loss)
4. Do you have trouble with orientation  ( getting lost, disoriented, losing track of time, not recognizing familiar places or persons)
5. Do yo have problems with judgment or solving everyday problems at home such as managing medications, money, cooking, or understanding explanations?
6. Do yo have trouble caring for yourself, for example, bathing, using the toilet,  dressing or eating?
7. Do you have trouble organizing your schedule or routine?