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Accurate diagnosis and prognosis are essential since the symptoms can be reversible with appropriate treatment, such as VP-shunt surgery. This study investigates the relationship between cerebrospinal fluid biomarkers, particularly Tau, Phospho-tau, the beta-amyloid ratio (A\u03b242\/A\u03b240), and neurocognitive outcomes post-surgery. Eighty patients diagnosed with iNPH who underwent shunt placement between November 2021 and July 2023 were included. A comprehensive neuropsychological test battery was administered before, one hour after, and one day after lumbar puncture, and six weeks and three months post-surgery. CSF samples were analyzed for tau, phospho-tau and the beta-amyloid ratio. Neuropsychological tests assessed various cognitive functions, including executive functions, psychomotor speed, language, and memory. Patients with a higher beta-amyloid ratio showed significant cognitive improvement post-surgery. Neuropsychological tests, such as the DemTect and Trail Making Test A &amp; B indicated enhanced performance over time, particularly at the three-month follow-up. Conversely, the MMSE did not show significant improvement. The data suggest that the beta-amyloid ratio is a potential prognostic marker for positive neurocognitive outcomes following VP-shunt surgery. The beta-amyloid ratio (A\u00df42\/A\u00df40) may represent a valuable prognostic biomarker for predicting cognitive improvement after VP-shunt surgery. Patients with higher ratios exhibited better neurocognitive outcomes, emphasizing the importance of comprehensive neuropsychological assessments. These findings support the potential of personalized treatment strategies based on biomarker analysis to optimize patient selection and improve outcomes for iNPH patients undergoing VP-shunt surgery.<\/jats:p>","DOI":"10.1007\/s10143-025-03609-8","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T02:19:38Z","timestamp":1749089978000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Neurocognitive effects of CSF biomarkers in idiopathic normal pressure hydrocephalus patients undergoing VP shunt placement"],"prefix":"10.1007","volume":"48","author":[{"given":"Hannah","family":"Spielmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magomed","family":"Lepshokov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Prajsnar-Borak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gudrun","family":"Wagenpfeil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Oertel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,5]]},"reference":[{"key":"3609_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 normal Cerebrospinal-Fluid pressure: A treatable syndrome. 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This article does not contain any studies with animals performed by any of the authors.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This study was approved by the local German ethical board (Ethikkommission der \u00c4rztekammer des Saarlandes, Saarbr\u00fccken, Germany), NO 147\/20. All participants of the study at hand gave their informed consent for participation in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Written informed consent was obtained from all patients (General Medical Council of the State of Saarland, NO 147\/20).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"484"}}