{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T07:26:33Z","timestamp":1793863593525,"version":"4.6.1"},"reference-count":115,"publisher":"FapUNIFESP (SciELO)","issue":"2","license":[{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dement. neuropsychol."],"abstract":"<jats:p>ABSTRACT. Normal-pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia and urinary incontinence. A critical review of the concept, pathophysiology, diagnosis, and treatment of both idiopathic and secondary NPH was conducted. We searched Medline and PubMed databases from January 2012 to December 2018 using the keywords \u201cnormal-pressure hydrocephalus\u201d \/ \u201cidiopathic normal-pressure hydrocephalus\u201d \/ \u201csecondary normal-pressure hydrocephalus\u201d \/ \u201cNPH\u201d \/ \u201cventriculoperitoneal shunt\u201d. The initial search produced 341 hits. After careful selection, a total of 54 articles were chosen and additional relevant studies were included during the process of writing this article. NPH is an important cause of potentially reversible dementia, frequent falls and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of non-invasive MRI methods for quantifying cerebral blood flow, in particular arterial spin-labeling (ASL), and the frequent association of NPH and obstructive sleep apnea (OSA), offer new avenues to understand and treat NPH.<\/jats:p>","DOI":"10.1590\/1980-57642018dn13-020001","type":"journal-article","created":{"date-parts":[[2019,6,26]],"date-time":"2019-06-26T15:35:30Z","timestamp":1561563330000},"page":"133-143","source":"Crossref","is-referenced-by-count":113,"title":["Normal-pressure hydrocephalus: A critical review"],"prefix":"10.1590","volume":"13","author":[{"given":"Louise Makarem","family":"Oliveira","sequence":"first","affiliation":[{"name":"Federal University of Amazonas,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Nitrini","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo C.","family":"Rom\u00e1n","sequence":"additional","affiliation":[{"name":"Neurological Institute,  USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2019,6]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1093\/brain\/awq014","article-title":"From congenital to idiopathic adult hydrocephalus A historical research","volume":"133","author":"Missori P","year":"2010","journal-title":"Brain"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/0022-510X(65)90016-X","article-title":"The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure Observations on cerebrospinal fluid hydrodynamics","volume":"2","author":"Hakim S","year":"1965","journal-title":"J Neurol Sci"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1056\/NEJM196507152730301","article-title":"Symptomatic occult hydrocephalus with \"normal\" cerebrospinal-fluid pressure A treatable syndrome","volume":"273","author":"Adams RD","year":"1965","journal-title":"N Engl J Med"},{"issue":"1","key":"ref4","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1227\/01.NEU.0000370058.12120.0E","article-title":"Salom\u00f3n Hakim and the discovery of normal-pressure hydrocephalus","volume":"67","author":"Wallenstein MB","year":"2010","journal-title":"Neurosurgery"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1001\/jama.1973.03220400024005","article-title":"Ventricular shunting for relief of senile symptoms","volume":"225","author":"Shenkin HA","year":"1973","journal-title":"JAMA"},{"key":"ref6","first-page":"1586","article-title":"Normal pressure hydrocephalus new concepts on etiology and diagnosis","volume":"21","author":"Bradley WG","year":"2000","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF01401149","article-title":"Conductance to outflow of CSF in normal pressure hydrocephalus","volume":"71","author":"B\u00f8rgesen SE","year":"1984","journal-title":"Acta Neurochir"},{"key":"ref8","first-page":"1166","article-title":"Idiopathic normal pressure hydrocephalus a systematic review of diagnosis and outcome","volume":"49","author":"Hebb AO","year":"2001","journal-title":"Neurosurgery"},{"issue":"2 Dementia","key":"ref9","first-page":"579","article-title":"Diagnosis and treatment of idiopathic normal pressure hydrocephalus","volume":"22","author":"Williams MA","year":"2016","journal-title":"Continuum"},{"issue":"4","key":"ref10","first-page":"514","article-title":"Is there even such a thing as \"Idiopathic normal pressure hydrocephalus\"?","volume":"82","author":"Saper C","year":"2017","journal-title":"Neurol"},{"issue":"3","key":"ref11","doi-asserted-by":"crossref","DOI":"10.3171\/2016.6.FOCUS16189","article-title":"Revisiting secondary normal pressure hydrocephalus does it exist? A review","volume":"41","author":"Daou B","year":"2016","journal-title":"Neurosurg Focus"},{"issue":"4","key":"ref12","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/ana.25046","article-title":"Deconstructing normal pressure hydrocephalus Ventriculomegaly as early sign of neurodegeneration","volume":"82","author":"Espay A","year":"2017","journal-title":"Ann Neurol"},{"issue":"5","key":"ref13","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.3171\/2010.12.JNS10106","article-title":"Potential placebo effect in assessing idiopathic normal pressure hydrocephalus","volume":"114","author":"Gupta A","year":"2011","journal-title":"J Neurosurg"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/0022-510X(65)90016-X","article-title":"The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure Observations on cerebrospinal fluid hydrodynamics","volume":"2","author":"Hakim S","year":"1965","journal-title":"J Neurol Sci"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1227\/01.NEU.0000168184.01002.60","article-title":"The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus INPH Guidelines, part III","volume":"57","author":"Marmarou A","year":"2005","journal-title":"Neurosurgery"},{"issue":"4","key":"ref16","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1590\/1980-57642015DN94000350","article-title":"Neuroimaging in normal pressure hydrocephalus","volume":"9","author":"Damasceno BP","year":"2015","journal-title":"Dement Neuropsychol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"775","DOI":"10.2176\/nmc.52.775","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus second edition","volume":"52","author":"Mori E","year":"2012","journal-title":"Neurol Med Chir"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ensci.2017.04.002","article-title":"Challenges in diagnosing normal pressure hydrocephalus: Evaluation of the diagnostic guidelines","volume":"7","author":"Andersson J","year":"2017","journal-title":"eNeurologicalSci"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1001\/archneur.60.8.1119","article-title":"Alzheimer disease in the US population prevalence estimates using the 2000 census","volume":"60","author":"Hebert LE","year":"2003","journal-title":"Arch Neurol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1097\/01.ju.0000155503.12545.4e","article-title":"Urologic diseases in America project urinary incontinence in males--demographics and economic burden","volume":"173","author":"Stothers L","year":"2005","journal-title":"J Urol"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1056\/NEJMoa020441","article-title":"Abnormality of gait as a predictor of non-Alzheimer's dementia","volume":"347","author":"Verghese J","year":"2002","journal-title":"N Engl J Med"},{"issue":"1-2","key":"ref22","first-page":"15","article-title":"The Differential Diagnosis and Treatment of Normal-Pressure Hydrocephalus","volume":"109","author":"Kiefer M","year":"2012","journal-title":"Dtsch Arztebl Int"},{"issue":"2","key":"ref23","doi-asserted-by":"crossref","first-page":"331","DOI":"10.3233\/JAD-130581","article-title":"Distinguishing Alzheimer's disease from Normal Pressure Hydrocephalus A Search for MRI Biomarkers","volume":"38","author":"Di Ieva A","year":"2013","journal-title":"J Alzheimers Dis"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1093\/brain\/awh178","article-title":"Normal pressure hydrocephalus (NPH) Ischaemia, CSF stagnation or both","volume":"127","author":"Silverberg GD","year":"2004","journal-title":"Brain"},{"key":"ref25","first-page":"97","article-title":"Normal pres\u00acsure hydrocephalus Neuropathological study. 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