Cerebrospinal Fluid Biomarkers in the Differential Diagnosis of Normal Pressure Hydrocephalus
DOI:
https://doi.org/10.5281/zenodo.22310359Keywords:
Normal pressure hydrocephalus, Cerebrospinal fluid biomarkers, Amyloid-beta, Tau protein, Shunt responsivenessAbstract
Background: Idiopathic normal pressure hydrocephalus (iNPH) is a treatable cause of gait disturbance, cognitive impairment
and urinary incontinence in older adults, but overlaps clinically with Alzheimer's disease (AD).
Objective: To review evidence on cerebrospinal fluid (CSF) biomarkers used to differentiate iNPH from AD and predict
shunt-responsiveness. Methods: Narrative review of diagnostic-criteria papers, biopsy-correlation studies, biomarker case-control series, meta-analyses and shunt-outcome cohorts. Findings: iNPH shows low amyloid-β42 with normal or modestly elevated tau/phospho-tau, contrasting with the low amyloid-β42/high tau pattern of AD; phospho-tau distinguishes the two with high sensitivity and specificity. Leucine-rich alpha-2-glycoprotein, neurofilament light chain and L1CAM add value. CSF tap testing retains higher specificity than any single biomarker for predicting shunt response. Conclusions: No single CSF biomarker substitutes for dynamic CSF testing, but biomarker panels usefully flag comorbid neurodegeneration and refine patient counselling.
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