Journal of Cerebral Blood Flow & Metabolism· 2026Q1
EXPRESS: Cerebral hemodynamic reserve and the prediction of shunt-responsive reversibility in idiopathic normal-pressure hydrocephalus
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- Q1SCImago
- 2026year
Short summary
Reversibility of deficits in idiopathic normal-pressure hydrocephalus (iNPH) may reflect recoverable hemodynamic reserve, a hypothesis testable within the current diagnostic pathway.
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Key points
- Shunting in iNPH selectively improves gait, but not cognition or continence.
- Static markers (e.g., white-matter hyperintensity, baseline CBF) do not predict shunt response.
- Impaired cerebrovascular reactivity is associated with favorable shunt response.
- Reversibility in iNPH may be linked to recoverable hemodynamic reserve.
AI-generated from the title and abstract; the full text is not read.
Abstract
The placebo-controlled PENS trial showed that shunting improves gait but not cognition or continence in idiopathic normal-pressure hydrocephalus (iNPH). This selective response highlights an unresolved problem: even among patients who respond to temporary cerebrospinal-fluid (CSF) drainage, we cannot predict which deficits will reverse after shunting. Static structural and perfusion markers, including white-matter hyperintensity load, cerebral small-vessel-disease burden, and baseline cerebral blood flow, do not predict shunt response. In contrast, impaired cerebrovascular reactivity is associated with a favorable response, yet cerebral autoregulation has not been measured before and after CSF diversion. I propose that reversibility in iNPH reflects recoverable hemodynamic reserve, and that this hypothesis can be tested within the existing diagnostic pathway.
The authors' abstract, as published at the source. Journal of Cerebral Blood Flow & Metabolism, 2026 · DOI ↗
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Field: Cellular and Molecular Neuroscience
Cellular and Molecular NeuroscienceNeuroscience