Cognitive Dysfunction* / therapy

Idiopathic Normal Pressure Hydrocephalus A Review

Nathan Hinkle — Wed, 16 Sep 2026 05:00:00 +0000

Date Added:

September 16, 2026

Journal/Publication:

JAMA

Publisher:

The American Medical Association

Publication Date:

September 14, 2026

URL:

E1-E14

Type:

Meta-analyses, Reviews, and Guidelines

CME Credits:

Format:

Article

DOI (1):

doi: 10.1001/jama.2026.15519

Keywords

Idiopathic Normal Pressure Hydrocephalus

neurology

cognitive assessment

MeSH

Hydrocephalus, Normal Pressure*

Cognitive Dysfunction* / therapy

urinary incontinence

RPR Commentary: A review of what we know about normal pressure hydrocephalus, and condition affecting up to 4% of older adults. James W. Mold, MPH.

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Abstract
Importance Idiopathic normal pressure hydrocephalus (iNPH) is a progressive neurological disorder characterized by cerebral ventricular enlargement that is typically associated with gait impairment and often urinary dysfunction and cognitive decline in older adults. iNPH prevalence is approximately 1% to 4% among individuals 65 years and older and 6% to 8% among those 80 years and older.

Observations iNPH is a multifactorial disorder involving interactions among cerebrospinal fluid (CSF) circulation, vascular dysfunction, and white matter injury. Unlike secondary NPH, iNPH occurs without a known antecedent event such as subarachnoid hemorrhage. Gait disturbance, including a broad-based, slow, shuffling gait and impaired turning, occurs in 85% to 95% of patients with iNPH and is often the earliest symptom. Urinary dysfunction occurs in approximately 75% to 90% of patients with iNPH and commonly includes urgency, nocturia, urge incontinence, or leakage. Cognitive impairment is reported in 60% to 80% of patients with iNPH, predominantly involving impaired attention, processing speed, working memory, verbal fluency, and cognitive flexibility. iNPH is diagnosed primarily based on characteristic clinical findings and neuroimaging (typically brain magnetic resonance imaging) demonstrating cerebral ventricular and subarachnoid space enlargement. Although necessary for diagnosis, these neuroimaging findings are not reliably associated with response to treatment. Early diagnosis of NPH is important because shorter symptom duration and less advanced disease are associated with more favorable outcomes. Patients being evaluated for iNPH should undergo large-volume lumbar puncture with removal of 30 to 50 mL of CSF to confirm the diagnosis and predict shunt responsiveness, measured as improvement in objective gait measures starting within hours after drainage. Extended lumbar drainage with removal of 200 to 300 mL of CSF over several days in an inpatient setting provides higher prognostic accuracy, and may be performed in patients with high clinical suspicion and a negative or equivocal clinical response to lumbar puncture. Treatment for iNPH is CSF diversion with shunt placement, most commonly performed with ventriculoperitoneal shunts, although ventriculoatrial and lumboperitoneal shunts may have similar efficacy. After shunting, approximately 75% to 80% of patients have gait velocity improvement; cognitive and urinary improvements occur in approximately 50% to 70%. Complications of shunts include overdrainage and underdrainage (10%-30%), presenting as postural headaches and subdural collections, and recurrence or worsening of iNPH symptoms, shunt malfunction (10%-20%), and shunt infections (<1%-2%).

Conclusions and Relevance iNPH affects approximately 1% to 4% of adults 65 years and older and is associated with gait impairment, cognitive decline, and urinary dysfunction. Symptoms improve in approximately 70% to 90% of patients with iNPH who undergo shunt surgery.

Author/s:

S. Farzad Maroufi, Sevil Yasar, Abhay Moghekar, Mark G. Luciano

Testosterone Treatment in Middle-Aged and Older Men with Hypogonadism

Megan George — Tue, 02 Sep 2025 13:52:11 +0000

Date Added:

September 2, 2025

Journal/Publication:

The New England Journal of Medicine

Publication Date:

August 6, 2025

URL:

Testosterone Treatment in Middle-Aged and Older Men with Hypogonadism

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMra2404637

Keywords

PMID (1):

40768717

MeSH

cardiovascular diseases

Urinary Retention

Hypogonadism

prostatic neoplasms

Cognitive Dysfunction* / therapy

pulmonary embolism

Lower Urinary Tract Symptoms

Anemia

A review of testosterone replacement in middle-aged and older men with hypogonadism. James W. Mold, MD, MPH

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•
In clinical trials involving middle-aged and older men with hypogonadism, testosterone treatment led to improved sexual activity and libido, correction of anemia, and modestly improved energy, mood, and walking ability. (The following key points also refer to findings from clinical trials involving this patient population.)
•
Testosterone treatment did not improve cognition in men without a previously diagnosed cognitive disorder and did not prevent progression to diabetes in men with prediabetes or improve glycemic control in those with diabetes.
•
Testosterone treatment did not increase the risk of major cardiovascular events among men with preexisting cardiovascular disease.
•
Testosterone treatment did not increase the risk of prostate cancer or acute urinary retention and did not worsen lower urinary tract symptoms.
•
Testosterone treatment was associated with an increased risk of clinical fractures and pulmonary embolism.
•
The decision to administer testosterone treatment in a man with hypogonadism should be based on the severity of the hypogonadism and an assessment of the potential benefits and risks of treatment.

Author/s:

Shalender Bhasin, Peter J Snyder

Effects of dance therapy on cognitive and mental health in adults aged 55 years and older with mild cognitive impairment: a systematic review and meta-analysis

Erin Blanchette — Mon, 13 Nov 2023 16:54:42 +0000

Date Added:

November 13, 2023

Journal/Publication:

BMC Geriatrics

Publisher:

BioMed Central

Publication Date:

October 26, 2023

Issue:

Volume:

695

URL:

Effects of dance therapy on cognitive and mental health in adults aged 55 years and older with mild cognitive impairment: a systematic review and meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1186/s12877-023-04406-y

Keywords

Dance therapy

Mild cognitive impairment

older adults

Cognitive

mental health

PMID (1):

37880590

MeSH

aged

Cognition

Cognitive Dysfunction* / therapy

dementia

dance therapy

Dance therapy improves cognitive function in people with mild cognitive impairment. Makes sense (Music plus physical activity). James W. Mold, MD, MPH

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Background: Individuals with mild cognitive impairment are at high risk of developing dementia. Dance therapy has promising applications in delaying cognitive decline. However, the effectiveness of dance therapy for older adults with mild cognitive impairment is unclear. The objective of this review was to evaluate the effectiveness of dance therapy on global cognitive function, specific cognitive subdomains, quality of life, and mental health in older adults with mild cognitive impairment to enrich health management strategies for dementia.

Methods: Electronic databases and grey literature were searched from inception up to September 23, 2023. The language was limited to English and Chinese. Relevant studies were screened and assessed for risk of bias. A meta-analysis and subgroup analyses stratified by measurement instrument, dance type, intervention duration, and frequency were conducted using the STATA 16.0 software. This review was conducted in accordance with the PRISMA guidelines.

Results: Ten studies involving 984 participants aged 55 years and over who met the eligibility criteria were included. Dance therapy significantly improved global cognitive function, memory, executive function, attention, language, and mental health (i.e., depression and neuropsychiatric symptoms). However, the effects of dance therapy on processing speed, visuospatial ability, and quality of life in older adults with mild cognitive impairment remain inconclusive. Moreover, dance interventions of longer duration (> 3 months) improved global cognition more than shorter interventions.

Conclusion: This review reported that dance therapy was effective in improving global cognitive function, memory, executive function, attention, language, and mental health (i.e., depression and neuropsychiatric symptoms). Hence, it may be an effective non-pharmacological complementary treatment for older adults with mild cognitive impairment.

Author/s:

Chen-shan Huang, Yuan-jiao Yan, Yu-ting Luo, Rong Lin, Hong Li