Physical activity and gait in patients with Idiopathic Normal Pressure Hydrocephalus: A literature review

Kathrin Oebel ¹ Tobias Moeller ¹ Julie Etingold ² Till Brombach ² Sana Aslam ³ Justin Lynn Hoskin ⁴ Yonas E. Geda ⁴ Alexander Woll ¹ Janina Krell-Roesch ^1*

• ¹ Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
• ² Städtisches Klinikum Karlsruhe, Karlsruhe, Baden-Württemberg, Germany
• ³ University of Colorado, Denver, Colorado, United States
• ⁴ Barrow Neurological Institute (BNI), Phoenix, Arizona, United States

Background: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by impaired gait and cognition, and urinary incontinence. Even though iNPH still lacks standardized diagnostic criteria, many patients may potentially benefit from treatment which are often invasive procedures.To provide an overview of the current state of research on physical activity behavior and gait in patients with iNPH, and examine potential changes after treatment (i.e., shunt surgery, spinal tap test or lumbar drainage).Methods: This literature review was carried out based on the PRISMA statement and we searched PubMed, Web of Science and Scopus databases in April 2023.In total, 32 studies were included: 29 focusing on gait, 2 focusing on gait and physical activity, and 1 focusing on physical activity. All studies reported improvements in gait, such as reduced gait ataxia or shuffling gait and greater variability of gait cycle length, after an intervention or treatment. Improvements may depend on patients' age, symptom duration, and treatment method, amongst others.Improvements in gait after iNPH treatment (e.g., shunt surgery) are well documented, whereas results on physical activity behavior in iNPH patients are inconsistent. More research on physical activity and gait outcomes before and after treatment, is needed, also with regard to treatment success.