The evaluation of dementia usually includes a consideration of normal pressure hydrocephalus, which may be a treatable aspect of the patient's cognitive dysfunction. This article outlines clinical syndromes, standard radiologic evaluation, and newer diagnostic tests that may suggest cerebrospinal fluid (CSF) shunting. In general, patients who present with dementia alone will not respond well to CSF shunting because of cerebral atrophy and the lack of tension within the cerebral ventricles. However, normal pressure hydrocephalus remains a diagnostic consideration, and improved evaluation may allow a better differentiation of which patients should be considered for CSF shunting.