Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Nov 23;10(1):9-16.
doi: 10.1002/mdc3.13608. eCollection 2023 Jan.

Clinical Features of Idiopathic Normal Pressure Hydrocephalus: Critical Review of Objective Findings

Brent Bluett  1 , Elissa Ash  2 , Amtul Farheen  3   4 , Alfonso Fasano  5   6   7   8 , Joachim K Krauss  9 , Alessio Maranzano  10   11 , Massimiliano Passaretti  12 , David F Tang-Wai  6   7   8   13 , Jay Van Gerpen  14 , Araceli Alonso-Canovas  15 , Jinyoung Youn  16 , Jan Malm  17 , Davide Martino  18 ; International Parkinson and Movement Disorder Society Normal Pressure Hydrocephalus Study Group
Affiliations
Review

Clinical Features of Idiopathic Normal Pressure Hydrocephalus: Critical Review of Objective Findings

Brent Bluett et al. Mov Disord Clin Pract. .

Abstract

Background: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by the classic clinical triad of gait, cognitive, and urinary dysfunction, albeit incomplete in a relevant proportion of patients. The clinical findings and evolution of these symptoms have been variably defined in the literature.

Objectives: To evaluate how the phenomenology has been defined, assessed, and reported, we performed a critical review of the existing literature discussing the phenomenology of iNPH. The review also identified the instrumental tests most frequently used and the evolution of clinical and radiologic findings.

Methods: The review was divided into 3 sections based on gait, cognitive, and urinary dysfunction. Each section performed a literature search using the terms "idiopathic normal pressure hydrocephalus" (iNPH), with additional search terms used by each section separately. The number of articles screened, duplicates, those meeting the inclusion criteria, and the number of articles excluded were recorded. Findings were subsequently tallied and analyzed.

Results: A total of 1716 articles with the aforementioned search criteria were identified by the 3 groups. A total of 81 full-text articles were reviewed after the elimination of duplicates, articles that did not discuss phenomenological findings or instrumental testing of participants with iNPH prior to surgery, and articles with fewer than 10 participants.

Conclusions: "Wide-based gait" was the most common gait dysfunction identified. Cognitive testing varied significantly across articles, and ultimately a specific cognitive profile was not identified. Urodynamic testing found detrusor overactivity and "overactive bladder" as the most common symptom of urinary dysfunction.

Keywords: cognition; gait; normal pressure hydrocephalus; phenomenology; urination.

PubMed Disclaimer

Figures

FIG. 1
FIG. 1
Flowchart of the selection process for the included studies in this critical literature review using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. iNPH, idiopathic normal pressure hydrocephalus; NPH, normal pressure hydrocephalus.
See this image and copyright information in PMC

References

    1. Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 1965;2(4):307–327. - PubMed
    1. Lee W, Lee A, Li H, Ong NYX, Keong N, Chen R, Chan LL. Callosal angle in idiopathic normal pressure hydrocephalus: Small angular mal‐rotations of the coronal plane affect measurement reliability. Neuroradiology 2021;63(10):1659–1667. - PubMed
    1. Fasano A, Espay AJ, Tang‐Wai DF, Wikkelso C, Krauss JK. Gaps, controversies, and proposed roadmap for research in Normal pressure hydrocephalus. Mov Disord 2020;35(11):1945–1954. - PubMed
    1. Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal‐pressure hydrocephalus. Neurosurgery 2005;57(3 Suppl):S4–S16. discussion ii‐v. - PubMed
    1. Ishikawa M. Guideline Committe for idiopathic Normal pressure hydrocephalus JSoNPH. Clinical guidelines for idiopathic normal pressure hydrocephalus. Neurol Med Chir (Tokyo) 2004;44(4):222–223. - PubMed

LinkOut - more resources