Challenges in Neuropsychological Improvement After Shunt Surgery for Idiopathic Normal Pressure Hydrocephalus

Adéla Bubeníková^1*Ondřej Rýdlo¹Petr Skalický¹Klára Häcklová²Robért Leško¹Aleš Vlasák¹Hana Georgi³Ondřej Bradáč¹

• ¹University Hospital in Motol, Prague, Czechia
• ²Ustredni vojenska nemocnice - Vojenska fakultni nemocnice Praha, Prague, Czechia
• ³Prazska vysoka skola psychosocialnich studii sro, Prague, Czechia

Structured Abstract Objectives: To evaluate cognitive and mood changes three 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 three months; seventy-one 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 three months patients still performed worse than controls on all tests (all p<0.001). Conclusions: Shunt surgery produces measurable yet domain-limited cognitive benefits in iNPH at three 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.