Objective: To examine changes in postural stability after CSF drainage using center of pressure (COP) analysis and their association with gait response in patients with iNPH.

Background: Gait disturbance is the most uncomfortable symptom of iNPH, and CSF drainage is commonly used to assess gait responsiveness. However, the relationship with postural stability remains unclear.

Method: Patients with probable iNPH (age ≥55 years with ventriculomegaly and gait disturbance) were included. Before and after CSF drainage, gait was assessed using the 3m Timed Up and Go (TUG) test and the 10m walk test, and postural stability was evaluated using a pressure plate system during 60 seconds of quiet standing. 18 COP parameters were derived, including mean distance, maximal distance, root mean square (RMS), range, confidence ellipse area (CEA), mean velocity, and power spectral density (PSD). Responders were defined as ≥10% improvement in either 3m TUG time or 10m gait velocity. COP changes were compared before and after CSF drainage, and between gait responders and non-responders. Correlations between gait and COP changes were analyzed, and between-group differences in COP were adjusted for age and Evan’s ratio.

Results: A total of 37 patients with probable iNPH were included (mean age 74.4 ± 6.7 years; 24 males), of whom 29 were responders. No significant COP changes were observed in the overall cohort. However, non-responders demonstrated significant increases in multiple COP parameters, including sway magnitude (AP, radius), range (AP, MLAP), mean velocity (ML, MLAP), CEA, and PSD (ML, AP), indicating worsening postural stability, whereas responders showed a tendency toward reduced postural sway. COP differed significantly between groups, with responders showing decreases and non-responders stable or increased values. After adjustment for age and Evan’s ratio, significant differences remained for mean distance (radius), RMS (AP and radius), CEA, and PSD (AP). Changes in 10m gait velocity were significantly correlated with changes in COP measures, including RMS (AP), CEA, and PSD (ML).

Conclusion: Postural stability changes after CSF drainage differed between gait responders and non-responders in iNPH. Responders showed reduced postural sway, whereas non-responders demonstrated worsening COP measures. Improvements in 10m gait velocity were associated with reductions in COP parameters.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/postural-stability-after-csf-drainage-in-idiopathic-normal-pressure-hydrocephalus-association-with-gait-response/