May 22, 2026

@michaelokun

Can a pill help normal pressure hydrocephalus? New randomized study says 'not yet.' Normal pressure hydrocephalus (NPH) is a brain condition where extra fluid enlarges the brain’s ventricles and can lead to walking difficulty, memory problems and bladder symptoms. Randomized means participants were assigned by chance. Double blind means neither participants nor health care providers knew who received the medication or placebo. Virhammar and colleagues describe in a new paper in The Lancet Neurology whether acetazolamide could improve symptoms in idiopathic normal pressure hydrocephalus while folks awaited shunt surgery. Key points: - Acetazolamide did not improve walking or overall clinical symptoms compared w/ placebo in folks w/ NPH. - Side effects including fatigue, tingling sensations, altered taste and stomach symptoms were more frequent in the treatment group. - MRI scans showed small brain imaging changes, however these changes did not translate into meaningful clinical improvement. My take: This was an important and carefully designed study. NPH remains one of the few potentially reversible causes of walking and cognitive decline in older adults, however this trial reminds us that not every promising biological idea translates into real world benefit. Shunt surgery remains the standard treatment for appropriately selected folks. Here are 5 points that resonated w/ me: 1- NPH is frequently under-recognized even though it can sometimes be treated successfully. 2- Walking changes in NPH are usually the most important symptom to follow in clinical trials. 3- Negative studies still move the field forward because they help sharpen future research directions. 4- MRI changes alone are not enough; what matters most is whether folks actually feel and function better. 5- The future likely lies in better biomarkers, earlier diagnosis and safer therapies for those who may not tolerate surgery. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(26)00126-2/fulltext #NPH #normalpressurehydrocephalus #parkinson