Clinical Characteristics and Recent Advances in the Diagnostic Approach for Idiopathic Normal Pressure Hydrocephalus

Lee, Seon-Min; Kwon, Kyum-Yil

doi:2026.44.2.101

J Korean Neurol Assoc > Volume 44(2); 2026 > Article

Review Article

Journal of the Korean Neurological Association 2026;44(2): 101-109. doi: https://doi.org/10.17340/jkna.2026.0007

특발 정상압수두증의 임상적 특징 및 진단적 접근의 최신 지견

이선민¹, 권겸일²

¹건양대학교병원 신경과
²순천향대학교 부속 서울병원 신경과

Clinical Characteristics and Recent Advances in the Diagnostic Approach for Idiopathic Normal Pressure Hydrocephalus

Seon-Min Lee MD¹, Kyum-Yil Kwon MD, PhD²

¹Department of Neurology, Konyang University Hospital, Daejeon, Korea
²Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul, Korea

Corresponding Author: Kyum-Yil Kwon ,Tel: +82-2-709-9026, Fax: +82-2-709-9226, Email: denovo78@naver.com

*These authors contributed equally to this work

Received: January 20, 2026 Revised: March 2, 2026 Accepted: March 5, 2026 Published online: May 1, 2026

Abstract

Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurological condition prevalent in the elderly, characterized by gait disturbance, cognitive decline, and urinary incontinence. Distinguishing iNPH from neurodegenerative mimics such as Alzheimer’s or Parkinson’s disease is critical to prevent missed treatment opportunities. This narrative review synthesizes current literature on the clinical presentation and diagnostic strategies for iNPH. Gait disturbance, often described as a magnetic gait, is typically the earliest sign and shows the most significant improvement following shunt surgery. Cognitive impairment manifests as frontal-subcortical dysfunction, distinct from the cortical memory deficits of Alzheimer’s disease. Diagnosis relies on integrating clinical history with specific magnetic resonance imaging findings, including disproportionately enlarged subarachnoid space hydrocephalus (DESH) and high-convexity tightness. While the cerebrospinal fluid (CSF) tap test is a valuable predictor for shunt responsiveness, clinicians must be wary of false-negative results. In addition, dopamine transporter imaging and amyloid imaging could be helpful to rule out other neurological disorders. Accurate diagnosis of iNPH requires a multidisciplinary approach combining clinical assessment, neuroimaging, and CSF dynamic evaluation. Timely identification and exclusion of comorbidities allow for effective surgical intervention, significantly reversing symptoms and improving the long-term quality of life for affected older adults.

Key Words: Hydrocephalus; Gait disorders | neurologic; Cognition disorders; Urinary incontinence; Cerebrospinal fluid shunts