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However, multiple pathologies mimic iNPH symptoms, making it difficult to select patients who will respond to shunt surgery. Although presenting features, extended lumbar drainage (ELD), infusion test (IT), intracranial pressure monitoring (ICPM), and tap test (TT) have been used to predict SR, uncertainty remains over which diagnostic test to choose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To conduct a systematic review and meta-analysis to identify clinical predictors of shunt responsiveness, evaluate their diagnostic effectiveness, and recommend the most effective diagnostic tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Embase, MEDLINE, Scopus, PubMed, Google Scholar, and JSTOR were searched for original studies investigating clinical predictors of SR in iNPH patients. Included studies were assessed using the QUADAS-2 tool, and eligible studies were evaluated using univariate and bivariate meta-analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-five studies were included. Nine studies discussed the diagnostic use of presenting clinical features, 8 studies ELD, 8 studies IT, 11 studies ICPM, and 6 studies TT. A meta-analysis of 21 eligible studies was conducted for TT, ELD, IT, and ICPM. ICPM yielded the highest diagnostic effectiveness, with diagnostic odds ratio (DOR)\u2009=\u200950.9 and area under curve (AUC)\u2009=\u20090.836. ELD yielded DOR\u2009=\u200927.70 and AUC\u2009=\u20090.753, IT had DOR\u2009=\u20095.70 and AUC\u2009=\u20090.729, and TT scored DOR\u2009=\u20093.86 and AUC\u2009=\u20090.711.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Intraparenchymal ICPM is statistically the most effective diagnostic test, followed by ELD, IT, and lastly TT. Due to the higher accessibility of TT and IT, they are recommended to be used first line, using a timed-up-and-go improvement\u2009\u2265\u20095.6\u00a0s or a Rout cut-off range between 13 and 16\u00a0mmHg, respectively. Patients who test negative should ideally be followed up with ICPM, using mean ICP wave amplitude\n                      <jats:inline-formula>\n                        <jats:alternatives>\n                          <jats:tex-math>$$\\ge$$<\/jats:tex-math>\n                          <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                            <mml:mo>\u2265<\/mml:mo>\n                          <\/mml:math>\n                        <\/jats:alternatives>\n                      <\/jats:inline-formula>\n                      4\u00a0mmHg, or 1- to 4-day ELD with an MMSE cut-off improvement\n                      <jats:inline-formula>\n                        <jats:alternatives>\n                          <jats:tex-math>$$\\ge$$<\/jats:tex-math>\n                          <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                            <mml:mo>\u2265<\/mml:mo>\n                          <\/mml:math>\n                        <\/jats:alternatives>\n                      <\/jats:inline-formula>\n                      3. Future research must use standardized methodologies for each diagnostic test and uniform criteria for SR to allow better comparison.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-021-04922-z","type":"journal-article","created":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T23:27:52Z","timestamp":1625700472000},"page":"2641-2672","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["Clinical predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"163","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9274-0350","authenticated-orcid":false,"given":"Santhosh G.","family":"Thavarajasingam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"El-Khatib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Rea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Russo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Lemcke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lana","family":"Al-Nusair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vajkoczy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,8]]},"reference":[{"key":"4922_CR1","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1056\/NEJM196507152730301","volume":"273","author":"RD Adams","year":"1965","unstructured":"Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH (1965) Symptomatic occult hydrocephalus with \u201cnormal\u201d cerebrospinal-fluid pressure. 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