title: The effect of shunt surgery on neuropsychological performance in normal pressure hydrocephalus: a systematic review and meta-analysis.
abstract: We conducted a systematic review of the literature and used meta-analytic techniques to evaluate the impact of shunt surgery on neuropsychological performance in patients with normal pressure hydrocephalus (NPH). Twenty-three studies with 1059 patients were identified for review using PubMed, Web of Science, Google scholar and manual searching. Inclusion criteria were prospective, within-subject investigations of cognitive outcome using neuropsychological assessment before and after shunt surgery in patients with NPH. There were statistically significant effects of shunt surgery on cognition (Mini-Mental State Examination; MMSE), learning and memory (Rey Auditory Verbal Learning Test; RAVLT, total and delayed subtests), executive function (backwards digit span, phonemic verbal fluency, trail making test B) and psychomotor speed (trail making test A) all in the direction of improvement following shunt surgery, but with considerable heterogeneity across all measures. A more detailed examination of the data suggested robust evidence for improved MMSE, RAVLT total, RAVLT delayed, phonemic verbal fluency and trail making test A only. Meta-regressions revealed no statistically significant effect of age, sex or follow-up interval on improvement in the MMSE. Our results suggest that shunt surgery is most sensitive for improving global cognition, learning and memory and psychomotor speed in patients with NPH.
authors.affiliation: Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Level 4 Box 189, Cambridge, CB2 0QQ, UK. kap45@medschl.cam.ac.uk.
authors.forename: Katie A
authors.identifier: http://orcid.org/0000-0001-8217-8918
authors.initials: KA
authors.lastname: Peterson
authors.affiliation: Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Level 4 Box 189, Cambridge, CB2 0QQ, UK.
authors.forename: George
authors.initials: G
authors.lastname: Savulich
authors.affiliation: MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge, UK.
authors.forename: Dan
authors.initials: D
authors.lastname: Jackson
authors.affiliation: Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Level 4 Box 189, Cambridge, CB2 0QQ, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Killikelly
authors.affiliation: Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: John D
authors.initials: JD
authors.lastname: Pickard
authors.affiliation: Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Level 4 Box 189, Cambridge, CB2 0QQ, UK.|MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Sahakian
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D003072:Cognition Disorders / Q000209:etiology* / Q000601:surgery; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000150:complications* / Q000601:surgery*; D009483:Neuropsychological Tests
keywords: Cognition; Neuropsychological tests; Neuropsychology; Normal pressure hydrocephalus; Shunt surgery