OBJECTIVES: To evaluate cognitive and mood changes 3 months after shunting for idiopathic normal-pressure hydrocephalus (iNPH), and compare postoperative outcomes with matched healthy controls across cognitive domains. METHODS: Thirty-three iNPH patients underwent neuropsychological testing preoperatively and at 3 months; 71 age-, sex-, and education-matched controls were assessed once. Tests were grouped into six cognitive domains. RESULTS: Shunting yielded significant gains in Verbal Memory and Psychomotor Pace; Executive Functions improved selectively. Non-Verbal Memory, Language, and Visuospatial Abilities showed no postoperative change. Depressive symptoms decreased significantly. However, at 3 months patients still performed worse than controls on all tests (all p < 0.001). CONCLUSION: Shunt surgery produces measurable yet domain-limited cognitive benefits in iNPH at 3 months, particularly in verbal learning and processing speed, alongside mood improvement. Performance remains below healthy norms, indicating partial recovery. Larger, prospective cohorts and longer follow-up are needed to determine durability, breadth of cognitive change, and predictors of response.

Department of Neuropsychology 1st Medical Faculty Charles University and Military University Hospital Prague Czechia

Department of Neuroscience 1st Medical Faculty Charles University Prague Czechia

Department of Neurosurgery 2nd Medical Faculty Charles University and Motol University Hospital Prague Czechia

Department of Neurosurgery and Neurooncology 1st Medical Faculty Charles University and Military University Hospital Prague Czechia

Prague College of Psychosocial Studies Prague Czechia

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Agerskov S., Hellström P., Andrén K., Kollén L., Wikkelsö C., Tullberg M. (2018). The phenotype of idiopathic normal pressure hydrocephalus-a single center study of 429 patients. J. Neurol. Sci. 391, 54–60. doi: 10.1016/j.jns.2018.05.022, PubMed DOI

Andersson J., Rosell M., Kockum K., Lilja-Lund O., Söderström L., Laurell K. (2019). Prevalence of idiopathic normal pressure hydrocephalus: a prospective, population-based study. PLoS One 14:e0217705. doi: 10.1371/journal.pone.0217705, PubMed DOI PMC

Bezdicek O., Stepankova H., Axelrod B. N., Nikolai T., Sulc Z., Jech R., et al. (2017). Clinimetric validity of the trail making test Czech version in Parkinson’s disease and normative data for older adults. Clin. Neuropsychol. 31, 42–60. doi: 10.1080/13854046.2017.1324045, PubMed DOI

Bianconi A., Colonna S., Minardi M., Di Perna G., Ceroni L., Nico E., et al. (2024). Prognostic factors in idiopathic Normal pressure hydrocephalus patients after Ventriculo-peritoneal shunt: results from a single-institution observational cohort study with long term follow-up. World Neurosurg. 187, e1089–e1096. doi: 10.1016/j.wneu.2024.05.060, PubMed DOI

Bonner-Jackson A., Mahmoud S., Miller J., Banks S. J. (2015). Verbal and non-verbal memory and hippocampal volumes in a memory clinic population. Alzheimer's Res Ther 7:61. doi: 10.1186/s13195-015-0147-9, PubMed DOI PMC

Bubeníková A., Sedlák V., Skalický P., Rýdlo O., Haratek K., Vlasák A., et al. (2025). Clinical improvement after shunt surgery in patients with idiopathic Normal pressure hydrocephalus can be quantified by diffusion tensor imaging. Am. J. Neuroradiol. 46, 766–773. doi: 10.3174/ajnr.A8571, PubMed DOI PMC

Bugalho P., Alves L., Miguel R., Ribeiro O. (2014). Profile of cognitive dysfunction and relation with gait disturbance in Normal pressure hydrocephalus. Clin. Neurol. Neurosurg. 118, 83–88. doi: 10.1016/j.clineuro.2014.01.006, PubMed DOI

Büyükgök D., Özdemir Ö., Ünal T. C., Barlas O. (2021). When to assess: cognitive impact of Ventriculoperitoneal shunt operation in elderly adults with Normal pressure hydrocephalus. World Neurosurg. 154, e302–e312. doi: 10.1016/j.wneu.2021.07.015, PubMed DOI

Caneva S., Hamedani M., Pesaresi A., Mori L., Marzi A., Pellegrino L., et al. (2025). Beyond early motor response: longitudinal cognitive and gait assessments after extended lumbar drainage in normal pressure hydrocephalus. Eur. J. Neurol. 32:e16567. doi: 10.1111/ene.16567, PubMed DOI PMC

Černochová D., Goldmann P., Král P., Soukupová T., Šnorek P., Havlůj V. (2010). Wechslerova inteligenční škála pro dospělé WAIS III. Prague: Hogrefe-Testcentrum.

Devito E. E., Pickard J. D., Salmond C. H., Iddon J. L., Loveday C., Sahakian B. J. (2005). The neuropsychology of normal pressure hydrocephalus (NPH). Br. J. Neurosurg. 19, 217–224. doi: 10.1080/02688690500201838, PubMed DOI

Drozdová K., Štěpánková H., Lukavský J., Bezdíček O., Kopeček M. (2015). Normativní studie testu Reyovy-Osterriethovy komplexní figury v populaci českých seniorů. Cesk. Slov. Neurol. Neurochir. 78/111, 542–549.

Duinkerke A., Williams M. A., Rigamonti D., Hillis A. E. (2004). Cognitive recovery in idiopathic Normal pressure hydrocephalus after shunt. Cogn. Behav. Neurol. 17, 179–184. doi: 10.1097/01.wnn.0000124916.16017.6a, PubMed DOI

Frydrychová Z., Kopeček M., Bezdíček O., Štěpánková Georgi H. (2018). České Normy Pro Revidovaný Reyův Auditorně-Verbální Test Učení (Ravlt) Pro Populaci Starších Osob. Ceskoslov. Psychol. 62, 330–349.

Gallina P., Lastrucci G., Caini S., Di Lorenzo N., Porfirio B., Scollato A. (2018). Accuracy and safety of 1-day external lumbar drainage of CSF for shunt selection in patients with idiopathic normal pressure hydrocephalus. J. Neurosurg. 131, 1011–1017. doi: 10.3171/2018.6.JNS18400, PubMed DOI

Hellström P., Edsbagge M., Blomsterwall E., Archer T., Tisell M., Tullberg M., et al. (2008). Neuropsychological effects of shunt treatment in idiopathic normal pressure hydrocephalus. Neurosurgery 63, 527–536. doi: 10.1227/01.NEU.0000325258.16934.BB, PubMed DOI

Hülser M., Spielmann H., Oertel J., Sippl C. (2022). Motor skills, cognitive impairment, and quality of life in normal pressure hydrocephalus: early effects of shunt placement. Acta Neurochir. 164, 1765–1775. doi: 10.1007/s00701-022-05149-2, PubMed DOI PMC

Israelsson H., Allard P., Eklund A., Malm J. (2016). Symptoms of depression are common in patients with idiopathic Normal pressure hydrocephalus: the INPH-CRasH study. Neurosurgery 78, 161–168. doi: 10.1227/NEU.0000000000001093, PubMed DOI

Kanno S., Saito M., Kashinoura T., Nishio Y., Iizuka O., Kikuchi H., et al. (2017). A change in brain white matter after shunt surgery in idiopathic normal pressure hydrocephalus: a tract-based spatial statistics study. Fluids Barriers CNS. 14:1. doi: 10.1186/s12987-016-0048-8, PubMed DOI PMC

Katzen H., Ravdin L. D., Assuras S., Heros R., Kaplitt M., Schwartz T. H., et al. (2011). Postshunt cognitive and functional improvement in idiopathic Normal pressure hydrocephalus. Neurosurgery 68, 416–419. doi: 10.1227/NEU.0b013e3181ff9d01, PubMed DOI PMC

Kopecek M., Stepankova H., Lukavsky J., Ripova D., Nikolai T., Bezdicek O. (2017). Montreal cognitive assessment (MoCA): normative data for old and very old Czech adults. Appl. Neuropsychol. Adult 24, 23–29. doi: 10.1080/23279095.2015.1065261, PubMed DOI

Krahulik D., Vaverka M., Hrabalek L., Hampl M., Halaj M., Jablonsky J., et al. (2020). Ventriculoperitoneal shunt in treating of idiopathic normal pressure hydrocephalus—single-center study. Acta Neurochir. 162, 1–7. doi: 10.1007/s00701-019-04135-5, PubMed DOI

Laidet M., Herrmann F. R., Momjian S., Assal F., Allali G. (2015). Improvement in executive subfunctions following cerebrospinal fluid tap test identifies idiopathic normal pressure hydrocephalus from its mimics. Eur. J. Neurol. 22, 1533–1539. doi: 10.1111/ene.12779, PubMed DOI

Lilja-Lund O., Maripuu M., Kockum K., Andersson J., Lindam A., Nyberg L., et al. (2023). Longitudinal neuropsychological trajectories in idiopathic normal pressure hydrocephalus: a population–based study. BMC Geriatr. 23:29. doi: 10.1186/s12877-023-03747-y, PubMed DOI PMC

Marmarou A., Young H. F., Aygok G. A., Sawauchi S., Tsuji O., Yamamoto T., et al. (2005). Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients. J. Neurosurg. 102, 987–997. doi: 10.3171/jns.2005.102.6.0987, PubMed DOI

Milani S. A., Marsiske M., Cottler L. B., Chen X., Striley C. W. (2018). Optimal cutoffs for the Montreal cognitive assessment vary by race and ethnicity. Alzheimer’s & Dementia: Diagnosis, Assessment Dis. Monitoring. 10, 773–781. doi: 10.1016/j.dadm.2018.09.003, PubMed DOI PMC

Nakajima M., Yamada S., Miyajima M., Ishii K., Kuriyama N., Kazui H., et al. (2021). Guidelines for management of idiopathic normal pressure hydrocephalus (third edition): endorsed by the Japanese Society of Normal Pressure Hydrocephalus. Neurol. Med. Chir. (Tokyo) 61, 63–97. doi: 10.2176/nmc.st.2020-0292, PubMed DOI PMC

Nasreddine Z. S., Phillips N. A., Bédirian V., Charbonneau S., Whitehead V., Collin I., et al. (2005). The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 53, 695–699. doi: 10.1111/j.1532-5415.2005.53221.x, PubMed DOI

Nikolai T., Štěpánková H., Michalec J. (2015). Testy verbální fluence, česká normativní studie pro osoby vyššího věku. Cesk. Slov. Neurol. Neurochir. 78/111, 292–299.

Ogino A., Kazui H., Miyoshi N., Hashimoto M., Ohkawa S., Tokunaga H., et al. (2006). Cognitive impairment in patients with idiopathic Normal pressure hydrocephalus. Dement. Geriatr. Cogn. Disord. 21, 113–119. doi: 10.1159/000090510, PubMed DOI

Passaretti M., Maranzano A., Bluett B., Rajalingam R., Fasano A. (2023). Gait analysis in idiopathic Normal pressure hydrocephalus: a Meta-analysis. Mov Disord Clin Pract. 10, 1574–1584. doi: 10.1002/mdc3.13816, PubMed DOI PMC

Peterson K. A., Savulich G., Jackson D., Killikelly C., Pickard J. D., Sahakian B. J. (2016). The effect of shunt surgery on neuropsychological performance in normal pressure hydrocephalus: a systematic review and meta-analysis. J. Neurol. 263, 1669–1677. doi: 10.1007/s00415-016-8097-0, PubMed DOI PMC

Picascia M. (2015). A review of cognitive impairment and differential diagnosis in idiopathic normal pressure hydrocephalus. Funct. Neurol. 30, 217–228. doi: 10.11138/FNeur/2015.30.4.217, PubMed DOI PMC

Rýdlo O., Bubeníková A., Häcklová K., Skalický P., Leško R., Ebelová A., et al. (2024). Comparison of decline in different cognitive domain in patients with normal pressure hydrocephalus. Neurosurg. Rev. 47:167. doi: 10.1007/s10143-024-02410-3, PubMed DOI PMC

Saito M., Nishio Y., Kanno S., Uchiyama M., Hayashi A., Takagi M., et al. (2011). Cognitive profile of idiopathic Normal pressure hydrocephalus. Dementia Geriatric Cognitive Disord. Extra. 1, 202–211. doi: 10.1159/000328924, PubMed DOI PMC

Savolainen S., Hurskainen H., Paljärvi L., Alafuzoff I., Vapalahti M. (2002). Five-year outcome of Normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta Neurochir. 144, 515–523. doi: 10.1007/s00701-002-0936-3, PubMed DOI

Shin C., Park M. H., Lee S. H., Ko Y. H., Kim Y. K., Han K. M., et al. (2019). Usefulness of the 15-item geriatric depression scale (GDS-15) for classifying minor and major depressive disorders among community-dwelling elders. J. Affect. Disord. 259, 370–375. doi: 10.1016/j.jad.2019.08.053, PubMed DOI

Shprecher D., Schwalb J., Kurlan R. (2008). Normal pressure hydrocephalus: diagnosis and treatment. Curr. Neurol. Neurosci. Rep. 8, 371–376. doi: 10.1007/s11910-008-0058-2, PubMed DOI PMC

Skalický P., Mládek A., Vlasák A., Whitley H., Bradáč O. (2022). First experiences with Miethke M.Blue® valve in iNPH patients. J. Clin. Neurosci. 98, 127–132. doi: 10.1016/j.jocn.2022.02.004, PubMed DOI

Solana E., Sahuquillo J., Junque C., Quintana M., Poca M. A. (2012). Cognitive disturbances and neuropsychological changes after surgical treatment in a cohort of 185 patients with idiopathic Normal pressure hydrocephalus. Arch. Clin. Neuropsychol. 27, 304–317. doi: 10.1093/arclin/acs002, PubMed DOI

Štěpánková H., Bezdíček O., Nikolai T., Horáková K., Lukavský J., Kopeček M. (2015). Zpráva o projektu Národní normativní studie kognitivních determinant zdravého stárnutí. E-psychologie 9, 43–64.

Sullivan G. M., Feinn R. (2012). Using effect size-or why the P value is not enough. J. Grad. Med. Educ. 4, 279–282. doi: 10.4300/JGME-D-12-00156.1, PubMed DOI PMC

Tang Y., Yao Y., Xu S., Li X., Hu F., Wang H., et al. (2021). White matter microstructural damage associated with gait abnormalities in idiopathic Normal pressure hydrocephalus. Front. Aging Neurosci. 13:660621. doi: 10.3389/fnagi.2021.660621, PubMed DOI PMC

Thomas G., McGirt M. J., Woodworth G., Heidler J., Rigamonti D., Hillis A. E., et al. (2005). Baseline neuropsychological profile and cognitive response to cerebrospinal fluid shunting for idiopathic normal pressure hydrocephalus. Dement. Geriatr. Cogn. Disord. 20, 163–168. doi: 10.1159/000087092, PubMed DOI

Xiao H., Hu F., Ding J., Ye Z. (2022). Cognitive impairment in idiopathic Normal pressure hydrocephalus. Neurosci. Bull. 38, 1085–1096. doi: 10.1007/s12264-022-00873-2, PubMed DOI PMC

Yesavage J. A., Brink T. L., Rose T. L., Lum O., Huang V., Adey M., et al. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. J. Psychiatr. Res. 17, 37–49. PubMed

Yeung P. Y., Wong L. L., Chan C. C., Wong L. L. L., Yung C. Y., Leung L. M. J., et al. (2020). Montreal cognitive assessment—single cutoff achieves screening purpose. Neuropsychiatr. Dis. Treat. 16, 2681–2687. doi: 10.2147/NDT.S269243, PubMed DOI PMC