Normal Pressure Hydrocephalus (NPH) is an age-related disorder contributing to an estimated 1-6% of all dementia in the elderly. NPH symptoms can be reversed with a ventriculo-peritoneal (VP) shunt, a mechanical device that permits drainage of excess cerebrospinal fluid (CSF). The recent advent of adjustable VP shunts that can be non-invasively reprogrammed over a wide range of pressures represents a major advance in the treatment of NPH. The adjustable shunt may allow a greater number of patients to achieve better cognitive recovery with fewer adverse outcomes by allowing gradual adjustments to intracerebral pressure that are not possible using a conventional fixed-pressure device. There is currently no published data on the neuropsychological impact of using adjustable shunts. The proposed study stands to yield results that will directly influence clinical decision-making. The long-term objectives of the current study are to define the pattern and course of cognitive recovery following shunt placement in NPH and to determine whether various shunting parameters have a differential impact on cognitive outcome. NPH patients will be implanted with a programmable valve system and will be randomized to two different shunt management groups. All patients will undergo neuropsychological testing at baseline, 10 days, three months, six months and nine months following surgery. Rate of improvement of different neuropsychological skills and the extent to which post-operative shunt pressure adjustments contribute to better cognitive and functional outcome will be examined. The study will also address the extent to which clinical response to pre-operative CSF drainage correlates with outcome following shunt placement. The candidate's near term goals are to develop research skills and expertise in the neuropsychological and biological aspects of age-related disorders affecting cognition and to establish a career as a clinical scientist. This Award would create an environment in which the candidate could focus the majority of her time on research in the area of aging and would allow her to pursue her long-range career objective, the development a fully independent research program in neurogeriatrics. New York Presbyterian Hospital-Weill Cornell Medical College (NYPH-WCMC) is a major academic medical center, an ideal environment for a developing clinical investigator. Both the environment and institutional commitment will foster the candidate's research career development and contribute to the success of the proposed research.
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