ArticleTherapeutic advances in neurological disorders2026
Stratified screening-based cognitive measures reveals temporal patterns of recovery after the CSF tap test in idiopathic normal pressure hydrocephalus (iNPH): A single-centre retrospective study.
Article in Therapeutic advances in neurological disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Idiopathic normal pressure hydrocephalus (iNPH) is a reversible disorder characterized by cognitive, gait, and urinary dysfunction. While the cerebrospinal fluid (CSF) tap test can predict surgical response, screening-based cognitive assessment protocols remain undefined, limiting prognostic accuracy. Objectives: To delineate temporal patterns of recovery for individual cognitive subdomains after the CSF tap test in patients with iNPH, and to establish high-sensitivity, time-stratified cognitive subdomains to improve preoperative prognostication and surgical decision-making. Design: Single-centre retrospective observational study with rigorous inclusion/exclusion criteria. All patients underwent a full series of multidimensional cognitive assessments before and at 24, 48, and 72 hours after the CSF tap test. Cognitive functions were stratified into six standardized subdomains using validated weighted composite scores. All enrolled patients underwent ventriculoperitoneal (VP) shunt surgery and completed 3-month postoperative cognitive follow-up. Longitudinal changes were analysed using repeated-measures ANOVA, linear mixed models, and receiver operating characteristic curve analysis. Methods: In this study, 53 patients with iNPH were included. Cognitive assessments were performed consistently across all time points using the Mini-Mental State Examination (MMSE), Animal Fluency Test (AFT), Trail Making Test (TMT and TMT-A), and Clock Drawing Test (CDT). Quantitative composite scores for each cognitive subdomain were computed and analysed longitudinally. Results: Stratified analyses showed that language ability at 24 hours (P < 0.01), orientation ability at 48 hours (P < 0.01), and recall combined with attention and calculation at 72 hours (recall: P < 0.001; attention and calculation: P < 0.01) were the most sensitive and predictive for assessing the effects of the CSF tap test across time points. All enrolled patients underwent VP shunt surgery after multi-index assessment. These improvements correlated with 3-month postoperative cognitive benefits. Conclusions: A time-stratified, subdomain-specific cognitive assessment protocol enhances tap test sensitivity, reduces misclassification, and supports personalized surgical decision-making for patients with iNPH.
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