• Robert A McGovern, Taylor B Nelp, Kathleen M Kelly, Andrew K Chan, Pietro Mazzoni, Sameer A Sheth, Lawrence S Honig, Andrew F Teich, and Guy M McKhann.
• Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota.
• Neurosurgery. 2019 Oct 1; 85 (4): E662-E669.

BackgroundThough it is well known that normal pressure hydrocephalus (NPH) patients can cognitively improve after ventriculoperitoneal shunting (VPS), one of the major dilemmas in NPH is the ability to prospectively predict which patients will improve.ObjectiveTo prospectively assess preoperative predictors of postshunt cognitive improvement.MethodsThis was a prospective observational cohort including 52 consecutive patients with approximately 1-yr follow-up. Patients underwent neuropsychological testing at baseline, postlumbar drainage, and postshunt. Cerebrospinal fluid (CSF) biomarkers and cortical biopsies were also collected to examine their relationship with postshunt cognitive improvement.ResultsRey Auditory Verbal Learning Test-L (RAVLT-L) was the only neuropsychological test to demonstrate statistically significant improvement both postlumbar drain and postshunt. Improvement on the RAVLT-L postlumbar drain predicted improvement on the RAVLT-L postshunt. Patients with biopsies demonstrating Aβ+ Tau+ had lower ventricular CSF Aβ42 and higher lumbar CSF pTau compared to Aβ- Tau- patients. A receiver operating curve analysis using lumbar pTau predicted Aβ+ Tau+ biopsy status but was not related to neuropsychological test outcome.ConclusionThe RAVLT can be a useful preoperative predictor of postoperative cognitive improvement, and thus, we recommend using the RAVLT to evaluate NPH patients. CSF biomarkers could not be related to neuropsychological test outcome. Future research in a larger patient sample will help determine the prospective utility of CSF biomarkers in the evaluation of NPH patients.Copyright © 2019 by the Congress of Neurological Surgeons.

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