Acta Medica · Sep 30, 2026

Improvement in geriatric syndromes following clinical response to endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus

By ÖZER YP, Özpişkin ÖM, Güner M et al.

Objective: Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible cause of functional and cognitive decline in older adults. Although endoscopic third ventriculostomy (ETV) has emerged as an alternative treatment option in selected patients, its multidimensional impact on geriatric syndromes remains unclear. This study aimed to evaluate changes in comprehensive geriatric assessment (CGA) parameters following ETV in patients with iNPH. Materials and Methods: This prospective observational study included 14 patients aged ≥55 years with iNPH who underwent ETV. Patients were categorized according to clinical improvement based on the iNPH Grading Scale. CGA domains—including Katz Activities of Daily Living (ADL), Lawton–Brody Instrumental (ADL), Clinical Frailty Scale (CFS), SARC-F, Mini Nutritional Assessment–Short Form (MNA-SF), Yesavage Geriatric Depression Scale (GDS), Older People’s Quality of Life Questionnaire (OPQOL), and the Quick Mild Cognitive Impairment Screen-Turkish Version (qMCI-TR) were evaluated preoperatively and at 1 and 3 months after ETV. Results: Eight patients (57.1%) demonstrated clinical improvement after ETV. At baseline, the clinical improvement group had higher Katz ADL, IADL, and qMCI-TR scores than the without improvement group. At 1st month, the clinical improvement group showed significant improvements in Katz ADL (Δ=1.0, p=0.025), CFS (Δ=−1.0, p=0.011), SARC-F (Δ=−2.0, p=0.011), MNA-SF (Δ=1.0, p=0.011), and OPQOL (p=0.017). At 3rd month, further significant improvements were observed in CFS (Δ=−1.0, p=0.011), OPQOL (Δ=6.0, p=0.017), SARC-F (Δ=−2.5, p=0.011), and MNA-SF (Δ=1.0, p=0.016). In contrast, patients without clinical improvement showed no consistent favorable changes across CGA domains. Conclusion: In older adults with iNPH, clinical response to ETV was associated with meaningful improvements across multiple geriatric domains, particularly frailty, sarcopenia risk, nutritional status, functional status, and quality of life. These findings suggest that the benefits of ETV may extend beyond the classical symptom triad and support the integration of CGA into the perioperative evaluation of patients with iNPH.

doi.org/10.32552/actamedica.2026.1285 Open access Interventions