There are many NPH assessing scales, most of which aim to assess (1) level of general activity, (2) severity of respective NPH symptoms, (3) response to interventions such as cerebrospinal fluid (CSF) drainage tests or shunt surgery, and (4) short- and long-term outcome. More recently, the caregiver burden is also being assessed. The requirement of any grading scale should be to clearly define each symptom and be highly reproducible by different observers. They should be able to detect the degree of change in symptoms following interventions such as CSF drainage or CSF shunt surgery. Most assessment scales are qualitative and some are quantitative. The criticism leveled against qualitative assessments is that, although clinically useful, each grade of the scale might not span a similar interval, that the scale itself might exhibit inter-observer difference, and that data are not normalized. In contrast, while quantitative assessments are objective, they may reflect a limited part of NPH symptomatology. It is clear that comparative studies of various grading scales are necessary.
Modified Rankin Scale
0. No symptoms at all
No significant disability despite symptoms; able to carry out all usual duties and activities
Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance
Moderate disability; requiring some help, but able to walk without assistance
Moderately severe disability; unable to walk and attend to bodily needs without assistance
Severe disability; bedridden, incontinent and requiring constant nursing care and attention
Dead
