[Idiopathic normal pressure hydrocephalus and the older patient]

Idiopathic Normal Pressure Hydrocephalus (iNPH) is characterized by the clinical triad of cognitive disorders, gait impairment and urinary incontinence. The treatment is the implantation of a ventriculoperitoneal shunt. At present there are still no high quality determinants to predict the long term outcome after shunt implantation, because studies are likely to be biased, use many different study methods and are difficult to interpret by potential concomitant neurodegenerative diseases, like Alzheimer and vascular dementia. Because this comorbidity also determines whether the expected positive outcome of a shunt outweighs the risk of complications, a critical multidisciplinary analysis of comorbidity, frailty and patient preferences is a precondition to realize added value.