Cognitive recovery in idiopathic normal pressure hydrocephalus after shunt.
OBJECTIVE
Evaluate long-term changes in cognition after ventriculoperitoneal shunt insertion in patients with idiopathic normal pressure hydrocephalus.


BACKGROUND
Although studies have indicated that treatment of normal pressure hydrocephalus with ventriculoperitoneal shunt improves gait, effects of treatment on cognition have been inconsistent. Several studies have reported no significant improvement on neuropsychological tests in patients with idiopathic normal pressure hydrocephalus. Selection of candidates for shunt surgery using a trial of controlled spinal fluid drainage via lumbar catheter may result in more consistent improvement in cognition.


METHODS
This was a prospective, longitudinal study of performance on neuropsychological tests before and 6 to 12 months after insertion of a ventriculoperitoneal shunt in 10 patients with idiopathic normal pressure hydrocephalus who showed improvement in at least 1 clinical symptom with temporary lumbar drainage. Nonparametric tests were used to evaluate change.


RESULTS
Significant group improvements at follow-up were demonstrated on tests of verbal memory as well as in 1 test of psychomotor speed. Eight of 10 patients showed improvement by more than 1 standard deviation on at least 1 memory test. Six of 10 patients improved significantly on more than 50% of the tests administered.


CONCLUSIONS
Patients with idiopathic normal pressure hydrocephalus who show clinical improvement (in any symptom) after lumbar drainage are likely to show significant long-term improvement in memory after ventriculoperitoneal shunt.
Duinkerke
Anja
A
Erasmus University Medical School, Rotterdam, Netherlands. argye@JHMI.edu
Williams
Michael A
MA
Rigamonti
Daniele
D
Hillis
Argye E
AE
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology* / Q000628:therapy; D004322:Drainage; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000150:complications* / Q000628:therapy*; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt