The Computerized General Neuropsychological INPH Test revealed improvement in idiopathic normal pressure hydrocephalus after shunt surgery

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The Computerized General Neuropsychological INPH Test (CoGNIT) provides the clinician and the researcher with standardized and accessible cognitive assessments in patients with idiopathic normal pressure hydrocephalus (INPH). CoGNIT includes tests of memory, executive functions, attention, manual dexterity, and psychomotor speed. Investigations of the validity and reliability of CoGNIT have been published previously. The aim of this study was to evaluate CoGNIT’s sensitivity to cognitive change after shunt surgery in patients with INPH.


Forty-one patients with INPH (median Mini-Mental State Examination score 26) were given CoGNIT preoperatively and at a postoperative follow-up 4 months after shunt surgery. Scores were compared to those of 44 healthy elderly control volunteers. CoGNIT was administered by either a nurse or an occupational therapist.


Improvement after shunt surgery was seen in all cognitive domains: memory (10-word list test, p < 0.01); executive functions (Stroop incongruent color and word test, p < 0.01); attention (2-choice reaction test, p < 0.01); psychomotor speed (Stroop congruent color and word test, p < 0.01); and manual dexterity (4-finger tapping, p < 0.01). No improvement was seen in the Mini-Mental State Examination score. Preoperative INPH test scores were significantly impaired compared to healthy control subjects (p < 0.001 for all tests).


In this study the feasibility for CoGNIT to detect a preoperative impairment and postoperative improvement in INPH was demonstrated. CoGNIT has the potential to become a valuable tool in clinical and research work.

Clinical trial registration no.: NCT01618500 (

ABBREVIATIONS CoGNIT = Computerized General Neuropsychological INPH Test; EF = executive functions; GDS = Geriatric Depression Scale; INPH = idiopathic normal pressure hydrocephalus; IQR = interquartile range; MMSE = Mini-Mental State Examination; PS = psychomotor speed; SEM = standard error of measurement.

Article Information

Correspondence Anders Behrens: Umeå University, Umeå, Sweden.

INCLUDE WHEN CITING Published online February 8, 2019; DOI: 10.3171/2018.10.JNS18701.

Disclosures Prof. Eklund has a royalty agreement with Likvor AB.

© AANS, except where prohibited by US copyright law.



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    CoGNIT generates a test report directly after testing. The report displays raw scores and comparisons to healthy elderly controls.

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    The mean pre- and postoperative scores for patients with INPH. The scores are normed so that 100% represents the mean score of healthy elderly controls, and larger scores always mean better performance.

  • View in gallery

    Distribution of summed Z-scores for healthy elderly controls and patients with INPH at baseline (left) and after shunt surgery (right).



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