Normal Pressure Hydrocephalus: A Retrospective Analysis of Elderly Patients Treated with Ventriculoperitoneal Shunts

Background/Objectives: Normal pressure hydrocephalus (NPH) is a neurodegenerative disease, a type of communicating hydrocephalus, in which excess cerebrospinal fluid builds up in the ventricles. It is a treatable cause of gait disturbance, cognitive decline and urinary incontinence in older adults. Early recognition and shunt treatment may substantially improve patient outcomes, yet data from Slovenia remain limited. This study aimed to analyze clinical characteristics, postoperative outcomes, and complications in elderly NPH patients treated with ventriculoperitoneal shunt (VPS) implantation at the University Medical Centre Ljubljana. Methods: A retrospective review was conducted in 98 patients aged ≥65 years who underwent VPS implantation for NPH between 2015 and 2025. Demographic data, symptom duration, pre- and postoperative clinical status (including Eide gait grading), comorbidities, and complications were collected from medical records and electronic medical database. Descriptive statistics and Mann-Whitney U tests were used; p < 0.05 was considered significant. Results: Ninety-eight patients (mean age 73.84 ± 5.59; 61.2% male, 38.8% female) were included. Gait disturbance was present in 95.9%, cognitive impairment in 84.2%, and urinary incontinence in 62.2%; 57.1% exhibited the complete Hakim triad. The mean symptom-to-surgery interval was 6.51 months. Postoperatively, the proportion of patients in severe gait stages (Eide 1–2) decreased from 38.3% to 12.0%, and 27.2% reached independent gait (grade 5). Cognitive improvement occurred in 78.8%, and urinary incontinence improved in 61.8%, with the full triad persisting in only 5.4%. Complications included shunt infection (2.0%) and intracerebral hemorrhage (6.1%). Revision surgery was needed in 14.9%, primarily due to overdrainage. Conclusions: VPS implantation led to significant improvement in gait, cognition, and continence in the majority of elderly NPH patients, with a low complication rate. These findings confirm surgical treatment as an effective and relatively safe option in this population and highlight the importance of timely diagnosis and multidisciplinary management.