Repeated cerebrospinal fluid removal procedure in older patients with idiopathic normotensive hydrocephalus ineligible for surgical treatment

Objectives: to evaluate the effects of repeated cerebral spinal fluid (CSF) tap test procedures in Idiopathic Normotensive Hydrocephalus (iNPH) patients ineligible for surgical treatment. Design: prospective, monocentric, pilot study. Setting: University Hospital. Participants: patients aged 75 year and older ineligible for shunting surgical intervention. Intervention: repeated CSF tap tests Measurements: all patients underwent a comprehensive geriatric assessment before and after each CSF tap test. Adverse events were recorded. Results: no major side effect was reported. Physical and cognitive functions improved after the drainage procedures except for continence, which was poorly influenced. According to clinical judgment, the mean time frame of benefit between CSF tap tests was 7 months. Patients dropping out from the study showed lower functional and cognitive performances with higher tendency to worsening over time. Conclusions: periodic CSF tap tests are safe, allow a better control of iNPH symptoms, and reduce the functional decline in geriatric patients.