Evaluating Cognitive Impairment in Idiopathic Normal-Pressure Hydrocephalus Through Rey Auditory Verbal Learning Test

Idiopathic normal-pressure hydrocephalus (iNPH) is clinically characterized by the Hakim-Adams triad: gait disturbance, cognitive decline, and urinary incontinence. Cognitive impairment in iNPH predominates as a subcortical syndrome, with deficits in executive functions, psychomotor slowing, and memory inefficiency. However, the cognitive profile is heterogeneous and often overlaps with other neurodegenerative conditions, complicating differential diagnosis. This study investigated the cognitive features of iNPH using the Rey Auditory Verbal Learning Test (RAVLT), comparing 29 iNPH patients to 28 healthy controls. Demographic and neuroimaging parameters-such as Evans Index and Callosal Angle-were assessed. Results indicated significantly lower Montreal Cognitive Assessment (MoCA) and RAVLT scores in iNPH patients compared to controls. Analysis of serial position effects revealed that, whereas healthy individuals exhibited typical primacy and recency effects in verbal memory, iNPH patients demonstrated a selective impairment of the primacy effect, likely reflecting hippocampal dysfunction. These findings underline the importance of detailed neuropsychological evaluation in differentiating iNPH from other dementias and suggest that damage to medial temporal lobe structures plays a prominent role in the verbal memory deficit observed in iNPH.