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Hellstr\u00f6m iNPH scale was used to quantify symptom burden pre- and postoperatively. CSF was collected at shunt insertion and postoperatively by shunt reservoir puncture, and analyzed for concentrations of GFAP, YKL40, MCP-1, NfL, A\u03b2\n                      <jats:sub>40<\/jats:sub>\n                      , sA\u03b2PP\u03b1, sA\u03b2PP\u03b2, GAP43, Alzheimer's disease biomarkers A\u03b2\n                      <jats:sub>42<\/jats:sub>\n                      , A\u03b2\n                      <jats:sub>42\/40<\/jats:sub>\n                      , total tau (T-tau), phosphorylated tau (P-tau), and neurogranin.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Concentrations increased postoperatively for A\u03b2\n                      <jats:sub>40<\/jats:sub>\n                      (134%), A\u03b2\n                      <jats:sub>42<\/jats:sub>\n                      (106%), sA\u03b2PP\u03b1 (112%), sA\u03b2PP\u03b2 (83%), NfL (128%), YKL40 (86%), GAP43 (124%), and MCP-1 (5%) (p\u2009&lt;\u20090.001, MCP-1 (p\u2009=\u20090.03)), while mean concentration reductions were seen in T-tau (32%), GFAP (31%), neurogranin (49%), and A\u03b2\n                      <jats:sub>42\/40<\/jats:sub>\n                      (10%) (p\u2009&lt;\u20090.001). A higher perioperative concentration of A\u03b2PP\u03b2 correlated with less pronounced gait disturbance (R\n                      <jats:sub>p<\/jats:sub>\n                      0.20 (0.01\u20130.38) (95% CI)), whereas higher levels of NfL (\u22120.23 (\u22120.41\u2013(\u2212)0.04) and MCP-1 (\u22120.21 (\u22120.37\u2013(\u2212)0.01)) correlated with impaired cognition. Higher MCP-1 correlated with a lower balance domain score (\u22120.20 (\u22120.37\u2013(\u2212)0.01)). Postoperative increases in levels of A\u03b2\n                      <jats:sub>40<\/jats:sub>\n                      (R\n                      <jats:sub>s<\/jats:sub>\n                      0.27 (0.05\u20130.46)), A\u03b2\n                      <jats:sub>42<\/jats:sub>\n                      (R\n                      <jats:sub>s<\/jats:sub>\n                      0.24 (0.02\u20130.44)) and YKL40 (R\n                      <jats:sub>s<\/jats:sub>\n                      0.22 (\u22120.00\u20130.43)) correlated with gait improvement, and a postoperative increase in A\u03b2\n                      <jats:sub>40<\/jats:sub>\n                      (R\n                      <jats:sub>s<\/jats:sub>\n                      0.36 (0.05\u20130.60)) was associated with improvement in urinary continence (p 0.01\u20130.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CSF biomarker concentrations change after shunt insertion. These changes, seen as increased concentrations for some biomarkers and decreased concentrations for others, are associated with improvement in core clinical symptoms and may illustrate reversibility of pathophysiological mechanisms in iNPH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13872877251350308","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T03:02:17Z","timestamp":1750388537000},"page":"1036-1048","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Postoperative changes in ventricular cerebrospinal fluid biomarkers with correlation to clinical outcome in idiopathic normal pressure hydrocephalus"],"prefix":"10.1177","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5453-8213","authenticated-orcid":false,"given":"Rebecca","family":"Gr\u00f8nning","sequence":"first","affiliation":[{"name":"Hydrocephalus Research Unit, Department of 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