The contribution of cerebral small vessel disease in idiopathic normal pressure hydrocephalus: Insights from a prospective cohort study

Abstract INTRODUCTION Idiopathic normal pressure hydrocephalus (iNPH) and cerebral small vessel disease (CVSD) are age‐related diseases, but their prevalence and clinical relationship are unclear. METHODS This prospective cohort study enrolled 95 patients with probable iNPH in China and evaluated their CSVD burden using magnetic resonance imaging. Linear regression models were used to analyze the association between CSVD scores and clinical outcomes. RESULTS The results showed 78% of the patients had at least one CSVD imaging marker, and higher total CSVD scores were significantly associated with declines in attention, executive function, psychomotor speed, and gait performance after multivariate adjustments. However, the preoperative CSVD score did not affect the post‐shunt improvement in modified Rankin scale or iNPH grading scale scores. DISCUSSION Our findings suggest that CSVD is prevalent in patients with iNPH and is associated with more severe symptoms, but it may not affect shunt outcomes. Future studies are needed to elucidate the underlying mechanisms. Highlights We found that 78% of the patients with idiopathic normal pressure hydrocephalus (iNPH) had at least one type of cerebral small vessel disease (CSVD) imaging marker. The CSVD burden aggravates cognitive and gait impairments in patients with iNPH but may not affect shunt outcomes. The effects of different imaging markers of CSVD on cognition and gait are different and worthy of further investigation.