The Neuropsychology of Adult Hydrocephalus

Adult hydrocephalus is a heterogeneous disorder with variable cognitive impairments among 4 subtypes: idiopathic normal pressure hydrocephalus (INPH), secondary hydrocephalus, unidentified congenital hydrocephalus, and transitional hydrocephalus. INPH is the most widely studied and presents with frontal subcortical dysfunction affecting psychomotor speed, information processing, executive skills, attention, and memory, ranging from mild to dementia-like impairments. Detailed neuropsychological evaluations are essential for diagnosis, assessing baseline impairment, and monitoring treatment response. Shunting can improve cognition in many patients, but outcomes vary based on symptom severity, disease duration, cerebrovascular burden, comorbidities, and affected cognitive domains. Further studies are needed to understand heterogeneity and enhance prediction of treatment efficacy.