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Zhang et al. Neuroimmunol Neuroinflammation 2020;7:109-19 Neuroimmunology
DOI: 10.20517/2347-8659.2019.018 and Neuroinflammation

Review Open Access

Cerebrospinal fluid biomarkers in idiopathic normal
pressure hydrocephalus

Xin-Jie Zhang , Jian Guo , Jun Yang #
#
#
Department of Neurosurgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361102,
Fujian, China.
# Authors contributed equally.
Correspondence to: Dr. Jun Yang, Department of Neurosurgery, Xiang’an Hospital of Xiamen University, School of Medicine,
Xiamen University, Xiamen 361102, Fujian, China. E-mail: junyangyang@hotmail.com
How to cite this article: Zhang XJ, Guo J, Yang J. Cerebrospinal fluid biomarkers in idiopathic normal pressure hydrocephalus.
Neuroimmunol Neuroinflammation 2020;7:109-19. http://dx.doi.org/10.20517/2347-8659.2019.018
Received: 28 Nov 2019 First Decision: 1 Feb 2020 Revised: 15 Feb 2020 Accepted: 16 Mar 2020 Available online: 11 May 2020

Science Editor: George P. Paraskevas Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by abnormal cerebrospinal fluid (CSF) flow
and consequent cerebral ventricular enlargement due to imbalance of CSF production and absorption. The
typical triad symptoms, namely cognitive decline, gait disturbance, and urinary incontinence, are thought to be
caused by disruption of CSF circulation. However, some patients may still experience symptomatic progression
after functional shunting, suggesting that iNPH is far more complicated than a simple disorder of CSF circulation.
Moreover, the diagnostic workup of iNPH can be challenging due to symptomatic and neuroimaging overlaps with
other neurological disorders, such as Alzheimer’s disease. Furthermore, accumulating studies indicate that the
pathogenesis of iNPH might relate to multiple mechanisms, including abnormalities of brain development, brain
extracellular matrix, synaptic function, blood flow, and cerebral metabolism. Therefore, iNPH is not an isolated
entity in occurrence and development. Nevertheless, different pathogeneses may result in protein content changes
in CSF, and the biomarkers in CSF may reflect the possible mechanisms involving the etiology of iNPH and are
potentially useful in assisting the diagnosis and treatment selection. In this review, we summarize the main findings
of CSF biomarkers and aim to outline a possible synthetic profile in assisting iNPH diagnosis and therapeutic options.

Keywords: Idiopathic normal pressure hydrocephalus, cerebrospinal fluid, biomarkers, neurodegenerative diseases

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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