Objective:

To evaluate the diagnostic effectiveness of presenting features and various tests in predicting shunt response (SR) in idiopathic normal pressure hydrocephalus (iNPH), highlighting its clinical significance.

Key Findings:

• Clinical improvement post-shunt surgery varies widely, with reported rates from 46.7% to 90%, indicating the need for better patient selection.
• Gait disturbance as a primary symptom significantly increases the likelihood of SR, suggesting a potential focus for diagnostic criteria.
• Current guidelines lack explicit diagnostic parameters and cut-off values for tests, which could lead to inconsistent patient evaluations.

Interpretation:

The review highlights the urgent need for updated guidelines and standardized diagnostic criteria to improve patient selection for shunt surgery in iNPH, ultimately enhancing patient outcomes.

Limitations:

• The review is based on studies with low to moderate risk of bias, and the heterogeneity of diagnostic tests may affect the results, potentially limiting the applicability of findings.
• Exclusion of radiological and biochemical studies limits the comprehensiveness of the analysis, which may overlook important diagnostic factors.

Conclusion:

There is a critical need for standardized diagnostic criteria and updated guidelines to enhance the prediction of shunt response in iNPH patients, which could significantly improve treatment outcomes.