Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus

To the Editor:We read with interest the article by McGirt et al. (9) entitled“Diagnosis, Treatment, and Analysis of Long-term Outcomes inIdiopathic Normal Pressure Hydrocephalus.” The authors con-clude that gait impairment is the primary symptom that inde-pendently predicted improvement after shunting. The studyincluded 132 patients, 129 (98%) of whom had gait impairmentas a feature. We would like to comment on this particular selec-tion criterion, as well as improvements in the Mini Mental StateExamination (MMSE) as the sole measure of postoperative cog-nitive improvement.One of the inclusion criteria for this study was presentationwith two or more features of the classic triad. Thus, the …