{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T21:10:22Z","timestamp":1792185022474,"version":"4.4.0"},"reference-count":45,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Objectives: Idiopathic normal-pressure hydrocephalus (NPH) is a treatable, but diagnostically challenging condition in the elderly marked by gait disturbance, cognitive decline, and urinary incontinence. Ventriculoperitoneal (VP) shunting is effective, but the prognostic significance of symptom duration before surgery remains unclear. This systematic review evaluates symptom duration in NPH patients with postoperative outcomes. Methods: A systematic search of PubMed, Scopus, and Embase was conducted per PRISMA guidelines. Studies were included if they assessed clinical or radiological outcomes of VP shunting in adult NPH patients, reported symptom duration, and had a follow-up of at least one month. Clinical outcomes (MMSE, TUG, NPH score) were qualitatively analyzed due to study heterogeneity. Results: Twenty-four studies comprising 1169 patients were included (mean age: 72.45 years; mean symptom duration: 33.04 months). Most studies reported clinical improvement after VP shunting. However, few directly evaluated the effect of symptom duration, yielding inconsistent findings: some suggested better outcomes with shorter symptom duration, while others found no clear correlation. Larger studies often lacked conclusive data, and no randomized controlled trials were identified. Conclusions: VP shunting remains an effective intervention for NPH; however, evidence supporting the predictive value of preoperative symptom length is inconclusive. This review highlights the need for standardized diagnostic protocols and larger prospective studies to clarify this association and optimize surgical timing.<\/jats:p>","DOI":"10.3390\/diagnostics15141778","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T08:04:41Z","timestamp":1752566681000},"page":"1778","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Time Course of Symptoms in Normal-Pressure Hydrocephalus: A Systematic Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7298-3240","authenticated-orcid":false,"given":"Bekir","family":"Rov\u010danin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Clinical Center University of Sarajevo, Bolni\u010dka 25, 71000 Sarajevo, Bosnia and Herzegovina"},{"name":"Faculty of Medicine, University of Sarajevo, \u010cekalu\u0161a 90, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5143-8801","authenticated-orcid":false,"given":"Ibrahim","family":"Omerhod\u017ei\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Center University of Sarajevo, Bolni\u010dka 25, 71000 Sarajevo, Bosnia and Herzegovina"},{"name":"Faculty of Medicine, University of Sarajevo, \u010cekalu\u0161a 90, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7856-773X","authenticated-orcid":false,"given":"Adem","family":"Nuhovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Clinical Center University of Sarajevo, Bolni\u010dka 25, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3988-8911","authenticated-orcid":false,"given":"Emir","family":"Begagi\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cantonal Hospital Zenica, Crkvice 67, 72000 Zenica, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5945-1311","authenticated-orcid":false,"given":"Nevena","family":"Mahmutbegovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Clinical Center Sarajevo, Bolni\u010dka 25, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakija","family":"Be\u010duli\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cantonal Hospital Zenica, Crkvice 67, 72000 Zenica, Bosnia and Herzegovina"},{"name":"Department of Anatomy, School of Medicine, University of Zenica, Travni\u010dka 1, 72000 Zenica, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haso","family":"Sefo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Center University of Sarajevo, Bolni\u010dka 25, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enra","family":"Mehmedika-Sulji\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Sarajevo, \u010cekalu\u0161a 90, 71000 Sarajevo, Bosnia and Herzegovina"},{"name":"Department of Neurology, University Clinical Center Sarajevo, Bolni\u010dka 25, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6786-9267","authenticated-orcid":false,"given":"Almir","family":"D\u017eurli\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Center University of Sarajevo, Bolni\u010dka 25, 71000 Sarajevo, Bosnia and Herzegovina"},{"name":"Sarajevo Medical School, University Sarajevo School of Science and Technology, Hrasni\u010dka cesta 3a, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6123-5589","authenticated-orcid":false,"given":"Mirza","family":"Pojski\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Marburg, 35033 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1227\/01.NEU.0000175724.00147.10","article-title":"Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure 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Chir."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e1089","DOI":"10.1016\/j.wneu.2024.05.060","article-title":"Prognostic Factors in Idiopathic Normal Pressure Hydrocephalus Patients After Ventriculo-Peritoneal Shunt: Results from a Single-Institution Observational Cohort Study with Long Term Follow-Up","volume":"187","author":"Bianconi","year":"2024","journal-title":"World Neurosurg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e16567","DOI":"10.1111\/ene.16567","article-title":"Beyond early motor response: Longitudinal cognitive and gait assessments after extended lumbar drainage in normal pressure hydrocephalus","volume":"32","author":"Caneva","year":"2025","journal-title":"Eur. J. Neurol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1778\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:47Z","timestamp":1760033387000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,14]]},"references-count":45,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["diagnostics15141778"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15141778","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,14]]}}}