Study Confirms Benefits of Shunt Surgery for Older Adults with Hydrocephalus

Recent research published in the New England Journal of Medicine has demonstrated that shunt surgery significantly improves symptoms in older adults diagnosed with idiopathic normal pressure hydrocephalus (iNPH). This condition, characterized by enlarged brain ventricles due to excess cerebrospinal fluid, often presents with gait difficulties, balance issues, cognitive decline, and urinary incontinence. Because these symptoms are common in the elderly and can be attributed to other causes, diagnosis can be challenging, leading to many cases remaining untreated.

The study, a comprehensive, randomized, double-blinded, multi-center trial involving 99 participants across 21 centers in the United States, Canada, and Sweden, found that implanting a brain shunt can markedly enhance motor functions and quality of life. The shunt system used in the trial includes a valve adjustable with a magnetic device, allowing clinicians to control cerebrospinal fluid drainage non-invasively.

Participants with open shunts experienced over double the minimum threshold increase in gait velocity compared to those with closed shunts, with 80% surpassing this significant improvement. These patients also reported fewer falls and better performance in daily activities. The ongoing evaluation aims to determine the long-term sustainability of these functional gains.

Dr. Michael A. Williams of the University of Washington, a lead author of the study, emphasized that the findings could dispel longstanding doubts among physicians regarding the existence and treatability of iNPH. The study’s results are expected to encourage more healthcare providers to consider shunt surgery for suitable patients, potentially improving outcomes for a population that is often underdiagnosed and undertreated.

The predominant age of participants was 75, with the prevalence of iNPH increasing with age—afflicting approximately 1.5% of individuals in their 70s and up to 7% of those in their 80s. Despite the availability of diagnostic tests such as MRI and response to spinal fluid removal, only a small fraction of diagnosed patients receive treatment, highlighting the need for increased awareness.

As the trial continues, researchers will employ more comprehensive neuropsychological assessments to evaluate cognitive improvements and measure MRI changes related to symptom reduction. The findings could lead to broader diagnosis and intervention, ultimately reducing health care costs and enhancing the well-being of elderly individuals affected by this condition.