Current Update on Treatment Strategies for Idiopathic Normal Pressure Hydrocephalus

  • Albert M. Isaacs
  • Michael A. Williams
  • Mark G. HamiltonEmail author
Dementia (J Pillai, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Dementia


Purpose of review

Idiopathic normal pressure hydrocephalus (iNPH) is a surgically treatable neurological disorder of the elderly population that is characterized by abnormal ventricular enlargement due to cerebrospinal fluid (CSF) accumulation and gait disturbance, cognitive impairment, or urinary incontinence. The objective of this review is to present the current diagnostic and treatment approaches for iNPH and to discuss some of the postoperative modalities that complement positive surgical outcomes.

Recent findings

Although historically reported patient outcomes following iNPH surgery were dismal and highly variable, recent advances in terms of better understanding of the iNPH disease process, better standardization of iNPH diagnostic and treatment processes arising from the adoption of clinical guidelines for diagnosis, treatment and in research methodologies, and availability of long-term follow-up data, have helped reduce the variations to a much improved 73 to 96% reported good outcomes.


With careful evaluation, good patient selection, and advanced surgical techniques, iNPH can be surgically treated to return patients close to their pre-iNPH functional status. Institution of an interdisciplinary effort to rehabilitate patients following surgery may help augment their recovery.


Normal pressure hydrocephalus Dementia Hydrocephalus Cerebrospinal fluid 


Compliance with Ethical Standards

Conflict of Interest

Albert M. Isaacs receives financial support as a graduate student from the Vanier Canada Graduate Scholarship and, recently from the Killam Predoctoral Scholarship programs.

Michael A. Williams currently is a recipient of a research grant from NASA on research on intracranial pressure. In 2017, Dr. Williams received honoraria and paid travel costs from Medtronic Inc. for preparation of independently developed lectures on hydrocephalus, which was presented at Neurosciences Grand Rounds, University of University of Saskatchewan College of Medicine. Dr. Williams is the Chair of the Medical Advisor board of the Hydrocephalus Association (HA). Dr. Williams is a member of the Board of Directors of the HA.

Mark G. Hamilton is a member of the Board of Directors of the HA. Dr. Hamilton received honoraria from Integra (Canada) Inc. for preparation of an independently developed seminar on adult hydrocephalus. Dr. Hamilton is the Chair of the Adult Hydrocephalus Clinical Research Network (AHCRN), Vice-Chair of the Medical Advisor board of the Hydrocephalus Association (HA) and a member of the Board of Directors of Hydrocephalus Canada.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Albert M. Isaacs
    • 1
    • 2
  • Michael A. Williams
    • 3
  • Mark G. Hamilton
    • 2
    • 4
    Email author
  1. 1.Department of NeuroscienceWashington University School of MedicineSt. LouisUSA
  2. 2.Division of Neurosurgery, Department of Clinical NeuroscienceUniversity of CalgaryCalgaryCanada
  3. 3.Adult and Transitional Hydrocephalus and CSF Disorders, Departments of Neurology and Neurological SurgeryUniversity of Washington School of MedicineSeattleUSA
  4. 4.Adult Hydrocephalus Program, Department of Clinical NeuroscienceUniversity of CalgaryCalgaryCanada

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