Composite score reflects total clinical burden from 0 to 9.
Symptomatic Sweep
Quantify the impact of the iNPH triad—walking, memory, and bladder—to establish a baseline for treatment response.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Quantifying the severity of Idiopathic Normal Pressure Hydrocephalus (iNPH) at baseline.
Following up gait, cognition, and continence after VP shunt insertion or a large-volume CSF tap test.
Section 2
Literature
Development
Published in 2008 by the Japanese NPH Study Group (SINPHONI) as part of the Japanese Clinical Practice Guidelines for iNPH. The scale was specifically designed to be administrable by any clinician without specialist neuropsychological testing, capturing all three limbs of the Hakim-Adams triad in a reproducible, ordinal format.
Section 3
Pearls/Pitfalls
Gait Responds First
The cardinal rule of shunt response in iNPH: Gait improves first and most dramatically, within days of shunting. Cognition improves secondarily over weeks. Bladder control is the last and least reliably recovered symptom. If a patient's gait does not improve after shunt insertion, the diagnosis of iNPH should be reconsidered.
Section 4
Evidence Appraisal
Primary Reference
Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus: Second Edition
Mori E et al. • Neurol Med Chir (Tokyo). 2012;52(11):775-809
