time of treatment was associated with better mRS scores 2 years later. The group that underwent treatment in their 80s saw slight improvements; however, their MMSE values 2 years later were low and their p-tau was high despite a high Aβ1–42/p-tau, indicating the severity of neuronaldamageandloss,suggestiveofadvancedpathologicalchanges associated with Alzheimer's disease (AD) impacting their cognitive skills [1]. Itshouldbenoted,however,thatthesestudyfindingsaretheresult of single-center experiences targeting an extremely small number of subjects. In addition to our small sample size, this study, similar to previousclinicalstudiesoniNPH,hasseveralfurtherlimitationsrelated to the patients' comorbidities [14]. In these studies, AD comorbidity could not be excluded before shunting. Large-scale clinical studies are needed to determine whether early initiation of shunt treatment can contribute to improvedcognitive function. Bothimproved and poor cognitivegroupsshowed arise in theconcentrationofL-PGDSandcystatinCintheCSFaftertheshunttreatment. L-PGDS, which is one of the most abundant CSF proteins and acts as a prostaglandin D2-producing enzyme and a lipophilic ligand-binding protein, is produced in the arachnoid membrane of the brain, spinal cord, and oligodendrocytes. Its lipophilic nature allows it to function as a chaperone, preventing the formation of neurotoxic agents such as Aβ fibrils [36]. It is thought to be secreted into the CSF as a β-trace protein, and combines with different Aβ fragments with a high level of affinity to constantly suppress Aβ aggregation [9]. Image data of the disproportionately enlarged subarachnoid-space hydrocephalus