{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T21:42:56Z","timestamp":1780609376823,"version":"3.54.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Idiopathic normal pressure hydrocephalus (iNPH) is characterized by impaired gait and cognition, and urinary incontinence. Even though iNPH still lacks standardized diagnostic criteria, many patients may potentially benefit from treatment which are often invasive procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To provide an overview of the current state of research on physical activity behavior and gait in patients with iNPH, and examine potential changes after treatment (i.e., shunt surgery, spinal tap test or lumbar drainage).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This literature review was carried out based on the PRISMA statement and we searched PubMed, Web of Science and Scopus databases in April 2023.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 32 studies were included: 29 focusing on gait, 2 focusing on gait and physical activity, and 1 focusing on physical activity. All studies reported improvements in gait, such as reduced gait ataxia or shuffling gait and greater variability of gait cycle length, after an intervention or treatment. Improvements may depend on patients\u2019 age, symptom duration, and treatment method, among others.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Improvements in gait after iNPH treatment (e.g., shunt surgery) are well documented, whereas results on physical activity behavior in iNPH patients are inconsistent. More research on physical activity and gait outcomes before and after treatment is needed, also with regard to treatment success.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1501709","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T07:05:12Z","timestamp":1742281512000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Physical activity and gait in patients with idiopathic normal pressure hydrocephalus: a literature review"],"prefix":"10.3389","volume":"16","author":[{"given":"Kathrin","family":"Oebel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Moeller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Etingold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"Brombach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Aslam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin L.","family":"Hoskin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonas E.","family":"Geda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Woll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janina","family":"Krell-Roesch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1111\/j.1468-1331.2010.03242.x","article-title":"Interest of dual-task-related gait changes in idiopathic normal pressure hydrocephalus","volume":"18","author":"Armand","year":"2011","journal-title":"Eur J Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"73","DOI":"10.24884\/0042-4625-2019-178-2-73-78","article-title":"Surgical treatment of idiopathic normal pressure hydrocephalus (literature rewiew)","volume":"178","author":"Gavrilov","year":"2019","journal-title":"Grek Bull Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S2-4","DOI":"10.1227\/01.NEU.0000168185.29659.C5","article-title":"Diagnosing idiopathic Normal-pressure hydrocephalus","volume":"57","author":"Relkin","year":"2005","journal-title":"Neurosurgery"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.2176\/nmc.48.S1","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus","volume":"48","author":"Ishikawa","year":"2008","journal-title":"Neurol Med Chir"},{"key":"ref5","doi-asserted-by":"publisher","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","year":"2012","journal-title":"Neurol Med Chir"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"63","DOI":"10.2176\/nmc.st.2020-0292","article-title":"Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (third edition): endorsed by the Japanese Society of Normal Pressure Hydrocephalus","volume":"61","author":"Nakajima","year":"2021","journal-title":"Neurol Med Chir"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1212\/CON.0000000000000305","article-title":"Diagnosis and treatment of idiopathic Normal pressure hydrocephalus","volume":"22","author":"Williams","year":"2016","journal-title":"Continuum"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1002\/mds.28251","article-title":"Gaps, controversies, and proposed roadmap for research in Normal pressure hydrocephalus","volume":"35","author":"Fasano","year":"2020","journal-title":"Mov Disord"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1111\/ene.14671","article-title":"Early shunt surgery improves survival in idiopathic normal pressure hydrocephalus","volume":"28","author":"Andr\u00e9n","year":"2021","journal-title":"Eur J Neurol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"977123","DOI":"10.3389\/fsurg.2022.977123","article-title":"One-year outcome of a lumboperitoneal shunt in older adults with idiopathic normal pressure hydrocephalus","volume":"9","author":"Fang","year":"2022","journal-title":"Front Surg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.clineuro.2012.05.009","article-title":"How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study","volume":"115","author":"Lundin","year":"2013","journal-title":"Clin Neurol Neurosurg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"845976","DOI":"10.3389\/fneur.2022.845976","article-title":"Physical capacity and activity in patients with idiopathic Normal pressure hydrocephalus","volume":"13","author":"Rydja","year":"2022","journal-title":"Front Neurol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"641561","DOI":"10.3389\/fsurg.2021.641561","article-title":"Outcomes of Ventriculoperitoneal shunt in patients with idiopathic Normal-pressure hydrocephalus 2 years after surgery","volume":"8","author":"Popal","year":"2021","journal-title":"Front Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref15","article-title":"Determining the scope of the review and the questions it will address","volume-title":"Cochrane handbook for systematic reviews of Interventions version 6.5","author":"Thomas","year":"2023"},{"key":"ref16","year":"2021"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"464","DOI":"10.25259\/SNI_112_2021","article-title":"Using smartphone-based accelerometers to gauge postoperative outcomes in patients with NPH: implications for ambulatory monitoring","volume":"12","author":"Sprau","year":"2021","journal-title":"Surg Neurol Int"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1016\/j.apmr.2015.02.014","article-title":"Instrumented gait analysis for an objective pre\u2212\/postassessment of tap test in normal pressure hydrocephalus","volume":"96","author":"Agostini","year":"2015","journal-title":"Arch Phys Med Rehabil"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1589\/jpts.19.183","article-title":"Recovery process of gait disturbance after ventriculo-peritoneal shunt in patients with idiopathic normal pressure hydrocephalus","volume":"19","author":"Ishii","year":"2007","journal-title":"J Phys Ther Sci"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1212\/01.wnl.0000078196.83215.4d","article-title":"Idiopathic normal pressure hydrocephalus predominantly with prolonged fever and hyponatremia","volume":"61","author":"Jung","year":"2003","journal-title":"Neurology"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"16255","DOI":"10.1038\/s41598-019-52448-3","article-title":"Quantitative gait analysis and cerebrospinal fluid tap test for idiopathic Normal-pressure hydrocephalus","volume":"9","author":"Lim","year":"2019","journal-title":"Sci Rep"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1016\/j.jocn.2008.12.007","article-title":"A prospective study of ventriculo-peritoneal shunting for idiopathic normal pressure hydrocephalus","volume":"16","author":"Razay","year":"2009","journal-title":"J Clin Neurosci"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.jocn.2015.10.044","article-title":"Clinical outcomes in the surgical treatment of idiopathic normal pressure hydrocephalus","volume":"29","author":"Shaw","year":"2016","journal-title":"J Clin Neurosci"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1678","DOI":"10.1016\/s1388-2457(00)00362-x","article-title":"Gait analysis in idiopathic normal pressure hydrocephalus\u2014which parameters respond to the CSF tap test?","volume":"111","author":"Stolze","year":"2000","journal-title":"Clin Neurophysiol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1097\/TGR.0b013e3181b02cdf","article-title":"Analysis of gait before and after cerebrospinal fluid lumbar tap test in idiopathic normal pressure hydrocephalus: a literature review and case report","volume":"25","author":"Warnecke","year":"2009","journal-title":"Top Geriatr Rehabil"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"194","DOI":"10.25122\/jml-2019-1004","article-title":"The effects of Ventriculoperitoneal shunt on gait performance","volume":"12","author":"Baltateanu","year":"2019","journal-title":"J Med Life"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1097\/01376517-200706000-00002","article-title":"Gait disorder is the cardinal sign of normal pressure hydrocephalus: a case study","volume":"39","author":"Fraser","year":"2007","journal-title":"J Neurosci Nurs"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"107405","DOI":"10.1016\/j.clineuro.2022.107405","article-title":"Quantitative gait analysis value as a predictor of shunt surgery effectiveness in normal pressure hydrocephalus: a technical note","volume":"221","author":"Gago","year":"2022","journal-title":"Clin Neurol Neurosurg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"635044","DOI":"10.3389\/fneur.2021.635044","article-title":"Quantitative evaluation of gait changes using APDM inertial sensors after the external lumbar drain in patients with idiopathic Normal pressure hydrocephalus","volume":"12","author":"He","year":"2021","journal-title":"Front Neurol"},{"key":"ref30","first-page":"301","article-title":"Evaluation of gait in normal pressure hydrocephalus before and after shunting","volume":"87","author":"Krauss","year":"2001","journal-title":"Adv Neurol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1111\/j.1600-0404.1995.tb00453.x","article-title":"Motor performance in normal pressure hydrocephalus assessed with an optoelectronic measurement technique","volume":"91","author":"Matousek","year":"1995","journal-title":"Acta Neurol Scand"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1111\/ane.13421","article-title":"Perceived and actual changes in gait balance after CSF shunting in idiopathic normal pressure hydrocephalus","volume":"144","author":"Nikaido","year":"2021","journal-title":"Acta Neurol Scand"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1590\/0004-282X20180037","article-title":"Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test","volume":"76","author":"de Souza","year":"2018","journal-title":"Arq Neuropsiquiatr"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/PHM.0b013e31815b6461","article-title":"Objective assessment of gait in normal-pressure hydrocephalus","volume":"87","author":"Williams","year":"2008","journal-title":"Am J Phys Med Rehabil"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2244","DOI":"10.1016\/j.apmr.2018.03.018","article-title":"Gait and balance measures can identify change from a cerebrospinal fluid tap test in idiopathic Normal pressure hydrocephalus","volume":"99","author":"Gallagher","year":"2018","journal-title":"Arch Phys Med Rehabil"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1111\/ane.13064","article-title":"A prospective study on gait dominant normal pressure hydrocephalus","volume":"139","author":"Song","year":"2019","journal-title":"Acta Neurol Scand"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"106402","DOI":"10.1016\/j.clineuro.2020.106402","article-title":"A comprehensive clinico-radiological, neuropsychological and biomechanical analysis approach to patients with idiopathic normal pressure hydrocephalus","volume":"201","author":"Wolfsegger","year":"2021","journal-title":"Clin Neurol Neurosurg"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1145\/2064942.2064947","article-title":"Analysis of gait in patients with normal pressure hydrocephalus","volume":"3","author":"Shrinivasan","year":"2011","journal-title":"mHealthSys"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"53","DOI":"10.18999\/nagjms.80.1.53","article-title":"Effect of spinal tap test on the performance of sit-to-stand, walking, and turning in patients with idiopathic normal pressure hydrocephalus","volume":"80","author":"Bovonsunthonchai","year":"2018","journal-title":"Nagoya J Med Sci"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.gaitpost.2018.01.008","article-title":"Relationship between gait parameters and MR imaging in idiopathic normal pressure hydrocephalus patients after shunt surgery","volume":"61","author":"Kitade","year":"2018","journal-title":"Gait Posture"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/s00702-020-02270-3","article-title":"Normal pressure hydrocephalus and CSF tap test response: the gait phenotype matters","volume":"128","author":"Morel","year":"2021","journal-title":"J Neural Transm"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.clineuro.2008.02.003","article-title":"Features of gait most responsive to tap test in normal pressure hydrocephalus","volume":"110","author":"Ravdin","year":"2008","journal-title":"Clin Neurol Neurosurg"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.jns.2018.05.022","article-title":"The phenotype of idiopathic normal pressure hydrocephalus-a single center study of 429 patients","volume":"391","author":"Agerskov","year":"2018","journal-title":"J Neurol Sci"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12987-021-00298-5","article-title":"The timed up and go test in idiopathic normal pressure hydrocephalus: a Nationwide study of 1300 patients","volume":"19","author":"Sundstr\u00f6m","year":"2022","journal-title":"Fluids Barriers CNS"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"148","DOI":"10.3171\/2015.12.JNS151663","article-title":"Walking assessment after lumbar puncture in normal-pressure hydrocephalus: a delayed improvement over 3 days","volume":"126","author":"Schniepp","year":"2017","journal-title":"J Neurosurg"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1501709\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T07:05:16Z","timestamp":1742281516000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1501709\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,18]]},"references-count":45,"alternative-id":["10.3389\/fneur.2025.1501709"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1501709","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,18]]},"article-number":"1501709"}}