Neural circuits of idiopathic Normal Pressure Hydrocephalus: A perspective review of brain connectivity and symptoms meta-analysis

Neurosci Biobehav Rev. 2020 May;112:452-471. doi: 10.1016/j.neubiorev.2020.02.023. Epub 2020 Feb 20.


Idiopathic normal pressure hydrocephalus (iNPH) is a prevalent reversible neurological disorder characterized by impaired locomotion, cognition and urinary control with ventriculomegaly. Symptoms can be relieved with cerebrospinal fluid drainage, which makes iNPH the leading cause of reversible dementia. Because of a limited understanding of pathophysiological mechanisms, unspecific symptoms and the high prevalence of comorbidity (i.e. Alzheimer's disease), iNPH is largely underdiagnosed. For these reasons, there is an urgent need for developing noninvasive quantitative biomarkers for iNPH diagnosis and prognosis. Structural and functional changes of brain circuits in relation to symptoms and treatment response are expected to deliver major advances in this direction. We review structural and functional brain connectivity findings in iNPH and complement those findings with iNPH symptom meta-analyses in healthy populations. Our goal is to reinforce our conceptualization of iNPH as to brain network mechanisms and foster the development of new hypotheses for future research and treatment options.

Keywords: Activation likelihood estimation; Brain connectivity; Brain network; Connectome; Diffusion MRI; EEG; Functional MRI; Idiopathic normal pressure hydrocephalus; Locomotion; Meta-analysis; Reversible dementia.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Connectome*
  • Electroencephalography
  • Humans
  • Hydrocephalus, Normal Pressure* / diagnostic imaging
  • Hydrocephalus, Normal Pressure* / pathology
  • Hydrocephalus, Normal Pressure* / physiopathology
  • Magnetic Resonance Imaging
  • Nerve Net* / diagnostic imaging
  • Nerve Net* / pathology
  • Nerve Net* / physiopathology
  • Transcranial Magnetic Stimulation