Objective: To identify demographic and clinical factors associated with global functional improvement, as measured by the modified Rankin Scale (mRS), in a retrospective cohort of patients with iNPH following neurosurgical intervention.

Background: Idiopathic Normal Pressure Hydrocephalus (iNPH) is characterized by the classic triad of gait apraxia, urinary incontinence, and cognitive decline. While ventriculoperitoneal (VPS) and ventriculoatrial (VAS) shunting are established treatments, there is a critical need to identify clinical predictors of long-term global functional recovery to better inform patient selection and counseling.

Method: We analyzed a retrospective cohort (N=113) of patients within the New York Presbyterian Weill Cornell and Brooklyn Methodist systems who underwent VPS or VAS for iNPH. The primary outcome was post-operative mRS change, categorized into improvers (N=25) and non-improvers (N=85) across multiple follow-up windows extending to 10 years. Baseline clinical features including age at onset, disease duration, and comorbidities were analyzed using bivariate comparisons and multivariable logistic regression.

Results: The mean age at procedure was 76 (SD 7) years, with a mean pre-operative mRS of 3. At early follow-up (1–3 months), 40.7% of the cohort showed mRS improvement. However, longitudinal analysis revealed that by the 5–10 year window, the proportion of improvers declined to 15.8%, while non-improvement increased to 40.4% [figure 1]. Improvers demonstrated a significantly younger age at onset compared to non-improvers (71 vs. 75 years, p=0.012). In the fully adjusted multivariable model controlling for sex, disease duration, pre-operative mRS, prior neurological surgeries, presence of psychiatric symptoms, presence of bradykinesia, polypharmacy, and imaging markers, younger age at onset remained the only significant predictor of global functional improvement (OR 0.93, 95% CI 0.85 –1.00, p=0.048). This suggests that each additional year of age at onset is associated with approximately 7% lower odds of improvement.

Conclusion: Younger age at onset is a significant predictor of favorable global functional response following shunt surgery in iNPH. These findings support the hypothesis that early diagnosis and intervention are critical to maximizing the potential for sustained functional recovery.

Long-term mRS Outcomes After Shunting in iNPH

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MDS Abstracts - https://www.mdsabstracts.org/abstract/global-functional-trajectory-and-predictors-of-improvement-in-idiopathic-normal-pressure-hydrocephalus-following-shunt-surgery/