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Normal Pressure HydrocephalusOWN-NPHNCT07103681

White Matter Distortion and Dementia Biomarkers in Normal Pressure Hydrocephalus (NPH)

An observational study of Normal Pressure Hydrocephalus, run by Imperial College London at 1 site in United Kingdom.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Idiopathic Normal Pressure Hydrocephalus (iNPH) is a progressive condition of the elderly that results in severe disability. iNPH can dramatically respond to Cerebral spinal fluid(CSF)-shunting where excess ventricular fluid is diverted from the brain. Not all patients with iNPH respond to CSF-shunting however. Read more about this study

Who is it for?
Ages 60 years and olderHealthy volunteers can take part
Conditions the study is for
Normal Pressure Hydrocephalus
What is being tested?
Ventriculoperitoneal Shunt (VP), Brain and Skin Biopsy and MRI Brain
Type of treatment
Surgery or procedure
How many people
100 participants
Where
1 siteUnited Kingdom
Study dates
25 Mar 2025to Feb 2029
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 60 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: Patients with hydrocephalus, neurodegenerative disease and healthy controls will be recruited by Dr Chris Carswell at Imperial College Hospital NHS Trust.

Who may be able to join

  • Adult patients >60
  • With gait apraxia
  • With or without cognitive impairment
  • Urinary dysfunction
  • Communicating Hydrocephalus
  • Healthy Carers
Show all 10Show fewer
  • Members of the Public
  • Staff of Imperial College/ICHT
  • Non-NPH Dementias (including Alzheimer's disease or vascular dementia)
  • Asymptomatic Hydrocephalus

Who cannot join

  • Asymptomatic hydrocephalus
  • High pressure-hydrocephalus
  • Serious head injury within 5 years of presentation or a clear secondary cause (e.g. brain infection)
  • History of childhood gait disturbance
  • Clear alternative explanation for symptoms (e.g. Parkinson's disease with limb rigidity, peripheral neuropathy with sensory ataxia, cervical myelopathy).
  • Too frail for shunt surgery
Show all 13Show fewer
  • Medically unstable (e.g. active angina, respiratory disease, recurrent delirium, active epilepsy).
  • Unable to tolerate MRI brain imaging
  • Unable to have a lumbar puncture
  • Immobile
  • Unable to attend the hospital for study visits
  • Group 2 (asymptomatic and non-hydrocepahlus dementia and healthy controls):
  • Unable to attend the hospital for study visits

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Chris Carswell contact

+44 20311 1234

NPH@imperial.ac.uk

Harvey G Burns contact

+44 20311 1234

NPH@imperial.ac.uk

United Kingdom1 site, 1 recruiting
  • Imperial College Healthcare NHS Trust

    London, W6 8RF

    Chris Carswell, PHD, FRCP, +44 20311 1234, NPH@imperial.ac.uk

    Harvey G Burns, +44 20311 1234, NPH@imperial.ac.uk

    Recruiting

Other trials in United Kingdom

About this study

Official title: Observational Study to Investigate the Effect of White Matter Tract Distortion and Neurodegenerative Biomarkers on Shunt-responsiveness in Idiopathic Normal Pressure Hydrocephalus (iNPH)

Idiopathic Normal Pressure Hydrocephalus (iNPH) is a progressive condition of the elderly that results in severe disability. iNPH can dramatically respond to Cerebral spinal fluid(CSF)-shunting where excess ventricular fluid is diverted from the brain. Not all patients with iNPH respond to CSF-shunting however. The reasons for this are uncertain.

Aim 1: To understand if specific nerve pathways (white matter tracts) that are near ventricles are damaged in patients that respond to shunting as opposed to those that do not.

Read more

Aim 2: Can we explain shunt non-responsiveness by screening for dementia like illnesses (neurodegeneration) using a large array of methods.

Aim 3: To understand whether wearable activity and bed sleep monitors are palatable in a NPH population and to understand if these metrics relate to quality of life.

Aim 4: To see whether self-administered digital cognitive assessments can measure improvements pre and post surgery.

Read the detailed description

This single-centre observational cohort study will follow 50 patients diagnosed with symptomatic Normal Pressure Hydrocephalus (NPH) (idiopathic or late presenting congenital hydrocephalus and not secondary hydrocephalus) through their clinical journey, from initial assessment to post-CSF shunt surgery or a time when surgery is decided against. Separate groups of 50 asymptomatic individuals with chronic hydrocephalus and non-hydrocephalus individuals will act as controls.

Participants will undergo comprehensive clinical assessments including gait, cognitive and urinary evaluations, quality of life measures, serum and CSF degenerative biomarker analysis, diffusion-weighted Magnetic Resonance Imaging (MRI) and optional brain and skin biopsies. Data collection will focus on capturing changes in clinical presentation and imaging findings before and after shunting. REDCap will be utilised as the primary tool for data storage.

Primary outcome measures assess pre and post-shunting imaging changes in shunt-responders and non-responders. Shunt response will be defined as 10% improvement in gait speed. Secondary outcomes evaluate the relationship between biomarkers and clinical outcomes. Longitudinal data will help identify factors distinguishing responders from non-responders, with descriptive and inferential statistics used.

Being tested
Ventriculoperitoneal Shunt (VP), Brain and Skin Biopsy, MRI Brain
Keywords
hydrocephalus, activity monitors, gait impairment, shunt surgery, protokinetic, normal pressure hydrocephalus, shunt-responsiveness, white matter tractography, diffusion tensor imaging, neurodegenerative, NPH
Medical subject headings
Hydrocephalus, Normal Pressure, Hydrocephalus

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Ventriculoperitoneal Shunt (VP)Procedure or surgery

    Also called VP Shunt

    VP Shunt surgery involves surgical insertion of a catheter (tube) to divert brain fluid from the cerebral ventricles to the abdominal peritoneum. This will be performed in Group 1 patients as clinically indicated.

  • Brain and Skin BiopsyProcedure or surgery

    Brain and skin biopsy's may be taken during the VP shunt to assist in histological analysis for neurodegenerative changes.

  • MRI BrainDiagnostic test

    MRI brain with diffusion imagining will be performed before and after shunt surgery.

Study groups in NCT07103681
Study groupRoleWhat they receive
Group 1Group 1 includes adults over 60 years old diagnosed with late-onset communicating hydrocephalus, characterised by gait apraxia, with or without cognitive impairment and urinary dysfunction. Eligibility is confirmed through clinical imaging showing an Evan's index >0.3 and an iNPH Radscale score >4. Individuals with recent severe head trauma, high-pressure hydrocephalus, or alternative causes for similar symptoms are excluded. This criteria for group 1 ensures a distinct group for studying the late-onset, communicating form of the condition.
Receives: Procedure: Ventriculoperitoneal Shunt (VP); Procedure: Brain and Skin Biopsy; Diagnostic Test: MRI Brain
Group 2Group 2 will include 30 adult patients with asymptomatic chronic hydrocephalus, non-hydrocephalus dementia and healthy controls.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. White Matter Pathway Diffusion Metrics

    Change from baseline in diffusion tensor imaging (DTI) metrics of white matter pathways (e.g. FA, AD, RD) before and after shunt surgery. The following tracts will be studied: corpus collosum, internal capsule, corona radiata and anterior thalamic radiation.

    Measured: Perioperative

Secondary outcomes (20)
  1. Neurodegenerative Biomarkers and CSF-shunt responsiveness

    Composite degenerative index (plasma abeta, GFAP, Ptau217, NfL, CSF synuclein RT QuIC and brain and skin histology) will be generated and compared between CSF shunt-responsive and CSF non-responsive groups.

    Measured: Perioperative

  2. Serum Neurodegenerative Biomarkers

    The serum biomarkers will measure a-beta (pg/ml), G-FAB (pg/ml), NfL (pg/ml) and p-tau217 (pg/ml).

    Measured: From enrolment, at periprocedural and up to 27 weeks

  3. Sleep Monitoring

    The Withings' Sleep mats are devices designed to track sleep patterns. Participants will be offered under mattress sleep monitors capable of showing time spent in bed and analyse sleep cycles.

    Measured: From enrolment and through study completion, an average of 1 year

  4. Activity Monitoring

    The Withings' Activity Monitors are devices designed to track physical activity and heart rate. Participants will be offered wrist activity monitors which capture data on steps taken, calories burned and overall movement throughout the day, providing insights into daily activity levels.

    Measured: From enrolment and through study completion, an average of 1 year

  5. Tinetti Performance Oriented Mobility Assessment Score (balance)

    Total scores range from 0 to 16, with higher scores indicating better outcomes of balance performance.

    Measured: From enrolment, at periprocedural and up to 27 weeks

  6. Tinetti Performance Oriented Mobility Assessment Score (Gait)

    Total scores range from 0 to 12, with higher scores indicating better outcomes of gait performance.

    Measured: From enrolment, at periprocedural and up to 27 weeks

  7. International Consultation on Incontinence Questionnaire for Urinary Incontinence Short Form (ICIQ UI SF)

    The assessment measures the frequency and severity of urinary incontinence. The total scores range from 0-21. Higher scores indicate worse bladder symptoms.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  8. International Consultation on Incontinence Questionnaire for Bowels (ICIQ-B)

    The assessment measures the pattern and control of bowel incontinence. The total scores for bowel pattern ranges from 1-21 and bowel control ranges from 0-28. Higher scores indicate worse bowel symptoms.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  9. International Consultation of Incontinence Questionnaire for Sexual Function

    The assessment measures the severity and bother of sexual function. The scores for sexual function range from 1-5 and are assessed on an individual basis. Higher scores indicate worse sexual function.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  10. International Consultation of Incontinence Questionnaire for Quality of Life

    The assessment measures the quality of life bladder, bowels and sexual function has on the individual. The scores suggest how much they bother the participant and it ranges from 0-10. Higher bother scores indicate lower quality of life.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  11. Overactive Bladder Symptoms (OAB)

    The total score ranges from 0 to 15, with higher scores indicating worse bladder severity symptoms.

    Measured: From enrolment, at periprocedural, and up to 27 weeks.

  12. Kubo scale

    Assesses gait disturbance, cognitive impairment and urinary disturbance. Total scores range from 0 to 12, with higher scores indicating better outcomes.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  13. Patient Health Questionnaire-9 (PHQ-9)

    Assesses the severity of depression. Total score ranges from 0 to 27, with higher scores indicating more severe depressive symptoms.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  14. Generalised Anxiety Disorder-7 (GAD-7)

    Assesses the severity of anxiety symptoms. Total scores range from 0 to 21, with higher scores indicating more severe anxiety.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  15. Sintonen 15D

    Overall score adds 15 metrics of quality of life. Total scores range from 75-15 with lower scores indicating better quality of life.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  16. PSP QoL

    Overall score adds 45 metrics of quality of life using a Likert scale to score from 0-5. Total scores range from 0-225 with lower scores indicating better quality of life.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  17. Rockwood Clinical Frailty Scale Score

    Frailty rating score in older adults. Total scores range from 1 to 9 with higher indicating greater frailty.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  18. Addenbrooke's Cognitive Examination ||| (ACE-|||)

    Total score evaluates cognitive functions including memory, language, visuospatial, attention and language. Total scores range from 0 to 100, with higher scores indicating better cognitive function.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  19. Cognitron Cognitive Assessment Platform

    Includes a total score of a collection of cognitive tests to assess various cognitive domains in those with NPH pre and post surgery. There are specific domain specific scores.

    Measured: From enrolment, at periprocedural and up to 27 weeks.

  20. PKMAS Gait Analysis Software

    Objective gait metric data is taken from the Protokinetics gait mat to analyse gait parameters of those with NPH. These metrics include, all aspects of gait (e.g. foot length, gait velocity, stride length)

    Measured: From enrolment, at periprocedural and up to 27 weeks.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Aug 2025
  2. Study start25 Mar 2025
  3. Primary completionFeb 2028 (estimated)
  4. Study completionFeb 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07103681
Sponsor's protocol ID
311620
Other IDs
W0300981
Acronym
OWN-NPH
Status last verified
Mar 2026
First submitted
3 Mar 2025
Last updated
27 Mar 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: IPD may be shared with collaborators if it is within the remit of the ethics approval and depending on the nature of the collaboration.

Questions about this trial

What is this clinical trial studying?

An observational study of Normal Pressure Hydrocephalus, run by Imperial College London at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 27 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Chris Carswell (+44 20311 1234, NPH@imperial.ac.uk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

White Matter Pathway Diffusion Metrics (time frame: Perioperative). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Mar 2026.

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