# Neurocognitive effects of CSF biomarkers in idiopathic normal pressure hydrocephalus patients undergoing VP shunt placement

## TL;DR

This study explores how cerebrospinal fluid biomarkers, especially the beta-amyloid ratio, predict cognitive improvement in patients with normal pressure hydrocephalus after shunt surgery.

## Contribution

The study identifies the beta-amyloid ratio as a novel prognostic biomarker for cognitive outcomes after VP-shunt surgery in iNPH patients.

## Key findings

- Patients with higher beta-amyloid ratios showed significant cognitive improvement post-surgery.
- Neuropsychological tests like DemTect and Trail Making Test A & B showed enhanced performance over time.
- The MMSE did not show significant improvement, highlighting the need for comprehensive assessments.

## Abstract

Idiopathic normal pressure hydrocephalus is an increasingly prevalent neurodegenerative condition among the elderly, characterized by the Hakim triad. Accurate diagnosis and prognosis are essential since the symptoms can be reversible with appropriate treatment, such as VP-shunt surgery. This study investigates the relationship between cerebrospinal fluid biomarkers, particularly Tau, Phospho-tau, the beta-amyloid ratio (Aβ42/Aβ40), and neurocognitive outcomes post-surgery. Eighty patients diagnosed with iNPH who underwent shunt placement between November 2021 and July 2023 were included. A comprehensive neuropsychological test battery was administered before, one hour after, and one day after lumbar puncture, and six weeks and three months post-surgery. CSF samples were analyzed for tau, phospho-tau and the beta-amyloid ratio. Neuropsychological tests assessed various cognitive functions, including executive functions, psychomotor speed, language, and memory. Patients with a higher beta-amyloid ratio showed significant cognitive improvement post-surgery. Neuropsychological tests, such as the DemTect and Trail Making Test A & B indicated enhanced performance over time, particularly at the three-month follow-up. Conversely, the MMSE did not show significant improvement. The data suggest that the beta-amyloid ratio is a potential prognostic marker for positive neurocognitive outcomes following VP-shunt surgery. The beta-amyloid ratio (Aß42/Aß40) may represent a valuable prognostic biomarker for predicting cognitive improvement after VP-shunt surgery. Patients with higher ratios exhibited better neurocognitive outcomes, emphasizing the importance of comprehensive neuropsychological assessments. These findings support the potential of personalized treatment strategies based on biomarker analysis to optimize patient selection and improve outcomes for iNPH patients undergoing VP-shunt surgery.

The online version contains supplementary material available at 10.1007/s10143-025-03609-8.

Not applicable.

The online version contains supplementary material available at 10.1007/s10143-025-03609-8.