Surgical Treatment Of Dementia

Question: When people say “surgical treatment of dementia,” which condition comes to mind?

Question: Is there a condition that resembles Alzheimer’s but can improve with surgery?

Answer: Yes: Idiopathic Normal Pressure Hydrocephalus (iNPH / NPH). Its classic triad is:

  1. Gait disturbance (slow, short-stepped, shuffling gait)
  2. Cognitive slowing / forgetfulness
  3. Urinary incontinence / urinary urgency

Question: What proportion of dementias may NPH account for?

Answer: Some sources state that NPH may represent about 5% of dementia cases.

Question: Does shunt surgery help, and what is the success rate?

Answer: In selected patients, studies reporting clinical improvement after shunt surgery have shown improvement rates of approximately 70–75% at the meta-analysis level.

What steps are followed when NPH is suspected?

  1. Neurological examination + gait assessment (ideally with standardized tests)
  2. Brain MRI / CT (e.g., ventricular enlargement and related findings)
  3. In appropriate patients, physician-directed tests such as diagnostic drainage / tap test
  4. Based on results, a risk–benefit discussion regarding the shunt option

The operation essentially involves placing a device called a shunt, which drains excess fluid in the brain—medically termed cerebrospinal fluid (CSF)—to the abdominal cavity through a thin tube that runs under the skin.

“If forgetfulness and slowed walking occur together, evaluation for treatable causes such as NPH can be considered.”