Early Cognitive, Functional, and Behavioral Changes after Ventriculoperitoneal Shunt Surgery in Idiopathic Normal Pressure Hydrocephalus: A Multicenter Prospective Study.

BACKGROUND

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by the clinical triad of gait disturbance, cognitive impairment, and urinary dysfunction. While ventriculoperitoneal shunt (VPS) surgery is an established treatment, the extent and pattern of early postoperative cognitive and behavioral changes remain incompletely understood. Most studies focus on gait outcomes or longer follow-up intervals, whereas evidence regarding early neuropsychological recovery is limited and heterogeneous. The aim of this study was to investigate early changes across multiple domains, including functional autonomy, global cognition, executive functions, processing speed, and apathy, one month after VPS surgery in patients treated for iNPH.

METHODS

A total of 73 patients undergoing VPS placement were prospectively evaluated before surgery (T0) and 1 month postoperatively (T1). The neuropsychological battery included the Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Clock Drawing Test (CDT), Digit Symbol Test, and Apathy Evaluation Scale (AES). Pre-post differences were primarily analyzed using paired-samples t-tests, with Wilcoxon signed-rank tests performed as sensitivity analyses when appropriate.

RESULTS

At one-month follow-up, significant improvements were observed in ADL (P < 0.001), IADL (P = 0.030), MMSE (P = 0.001), CDT (P = 0.006), Digit Symbol (P = 0.012), and AES (P < 0.001). Executive functions, as measured by the FAB, did not show statistically significant change (P = 0.122).

CONCLUSIONS

In this prospective cohort, the one-month follow-up after VPS surgery was associated with early changes in functional, cognitive, and behavioral domains in patients with iNPH. The observed pattern suggests domain-specific early responses, with measurable changes in functional autonomy, processing speed, visuoconstructive abilities, and apathy, alongside relative stability of executive functions. These findings should be interpreted as early postoperative trajectories rather than definitive outcomes and support the role of multidimensional neuropsychological assessment, including clinically meaningful change thresholds when available, in postoperative evaluation.