SUMMARY
# CSF Dynamic Biomarkers for Differential Diagnosis of NPH vs AD with Concomitant NPH
## Background and Rationale
Normal pressure hydrocephalus (NPH) and Alzheimer's disease (AD) present a complex diagnostic challenge in clinical neurology, as these conditions frequently co-occur and share overlapping symptomatology including cognitive impairment, gait disturbances, and urinary incontinence. The prevalence of NPH in the elderly population ranges from 0.2-2.9%, while concomitant AD pathology is f
METHODOLOGY NOTES
## PROTOCOL: CSF Dynamic Biomarkers for Differential Diagnosis of NPH vs AD with Concomitant NPH
**Phase 1: Patient Recruitment and Stratification (Months 1-6)**
Recruit 240 participants across three diagnostic cohorts: isolated NPH (n=80), isolated AD (n=80), and NPH with concomitant AD pathology (n=80). All participants must meet established diagnostic criteria: NPH diagnosed via clinical triad (cognitive decline, gait disturbance, urinary incontinence) with characteristic ventriculomegaly on MRI/CT and positive response to CSF tap test; AD diagnosed via amyloid-beta 42, phosphorylated tau-181, and total tau thresholds per ATN framework. Perform comprehensive neuropsychological assessment using Montreal Cognitive Assessment (MoCA), Mini-Cog, and Trail Making Test. Document comorbidities, medications, and prior neuroimaging. Randomize into primary cohort (n=160) and validation cohort (n=80) stratified by age (±5 years) and disease severity.
**Phase 2: CSF Collection and Pre-analytic