A study published in the New England Journal of Medicine examines the effectiveness of shunt surgery for idiopathic normal pressure hydrocephalus (iNPH) in older adults. Patients were randomly divided into an open shunt group (pressure 110 mm H₂O, allowing cerebrospinal fluid outflow) and a placebo group (pressure above 400 mm H₂O, preventing outflow). The open shunt significantly improved walking, balance, and reduced the number of falls—only 25% of patients in this group reported a fall versus 46% in the placebo group.[1][2] Imaging studies confirmed a reduction in the volume of the lateral ventricles of the brain in the open shunt group.[2] The placebo group had more falls, while the open shunt group showed a higher risk of cerebral or subdural hemorrhage (14% vs. 4%) and positional headaches (59% vs. 28%).[2] Most complications could be resolved by adjusting the shunt setting.[2] The PENS study will continue to follow patients for up to 12 months to assess long-term outcomes, including cognitive function.[1][2] iNPH affects up to 1.5% of people in their late 60s and 1 in 13 over the age of 86, with symptoms such as gait, memory and urinary incontinence.[1]