Postshunt cognitive and functional improvement in idiopathic normal pressure hydrocephalus

Heather Katzen, Lisa D. Ravdin, Stephanie Assuras, Roberto Heros, Michael Kaplitt, Theodore H. Schwartz, Matthew Fink, Bonnie E. Levin, Norman R. Relkin

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


BACKGROUND: Improvement in gait after shunt placement has been well documented in idiopathic normal pressure hydrocephalus (iNPH); however, controversy remains regarding the extent and pattern of postsurgical cognitive changes. Conflicting findings may be explained by variability in both test selection and follow-up intervals across studies. Furthermore, most investigations lack a control group, making it difficult to disentangle practice effects from a true treatment effect. OBJECTIVE: To examine postshunt changes in a sample of well-characterized iNPH participants compared with a group of age- and education-matched healthy control subjects. METHODS: We identified 12 participants with iNPH undergoing shunt placement and 9 control participants. All participants were evaluated with comprehensive neuropsychological testing and standardized gait assessment at baseline and were followed up for 6 months. RESULTS: Repeated-measures analysis of variance revealed a significant group- (iNPH and control) by-time (baseline and 6 months) interaction for Trailmaking Test B: (P > .003) and Symbol Digit Modalities (P > .02), with greater improvement in iNPH participants relative to control subjects. In addition, the iNPH group showed greater improvement in gait (P > .001) and caregivers reported improved activities of daily living (P > .01) and reduced caregiver distress (P > .01). CONCLUSION: This study demonstrates improvements in mental tracking speed and sustained attention 6 months after shunt placement in iNPH. The present investigation is the first study to use a controlled design to show that cognitive improvement in iNPH is independent of practice effects. Furthermore, these findings indicate functional and quality-of-life improvements for both the shunt responder and their caregiver.

Original languageEnglish (US)
Pages (from-to)416-419
Number of pages4
Issue number2
StatePublished - Feb 2011


  • Cognition
  • Neuropsychology
  • Normal pressure hydrocephalus
  • Ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


Dive into the research topics of 'Postshunt cognitive and functional improvement in idiopathic normal pressure hydrocephalus'. Together they form a unique fingerprint.

Cite this