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Participants underwent clinical, cognitive, and imaging assessments, high-volume lumbar puncture (LP). LP responders were referred for shunt placement, and outcomes assessed at one year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      183 patients were evaluated; 167 met criteria for suspected iNPH and underwent LP. Sixty-two (37%) patients showed improvement after CSF drainage and were referred for shunting. Of these, 38 (61%) underwent shunt placement. Gait disturbance was the most common presenting symptom (68%), and more frequent in LP responders (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007), whereas cognitive symptoms were more common among non-responders (29.5% vs. 10%). LP responders had lower CSF total tau (t-tau) (222.6\u2009\u00b1\u200999.1 vs. 256\u2009\u00b1\u2009107.1,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045) and protein (41.1\u2009\u00b1\u200917.1 vs. 49.1\u2009\u00b1\u200925.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032) and were more likely to exhibit a disproportionately enlarged subarachnoid-space hydrocephalus (DESH) pattern (73% vs. 46%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Among the 38 shunted patients, 21 (55%) had a favourable outcome at one year, which was associated with lower t-tau (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.056) and more frequent DESH (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Over half of patients who underwent shunt placement experienced favorable clinical outcomes at one year. Lower t-tau and DESH pattern were associated with better outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-026-06839-x","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T07:43:14Z","timestamp":1774251794000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of shunt responsiveness and outcomes in idiopathic normal pressure hydrocephalus: a retrospective cohort study"],"prefix":"10.1007","volume":"168","author":[{"given":"Dror","family":"Shir","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noa","family":"Bregman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Roth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elissa","family":"Ash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Shiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"6839_CR1","doi-asserted-by":"publisher","unstructured":"(1986) Graff-Radford NR GJCN-PHO of GABDPGS Outcome A Neurol 43(9):940\u2013942. https:\/\/doi.org\/10.1001\/archneur. 1986. 00520090068020 16. 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