Abstract: Objective To explore the effect of adjustable shunt in the treatment of idiopathic normal pressure hydrocephalus (INPH). Methods A total of 40 patients with INPH admitted to Shantou Central Hospital from January 1, 2016 to May 30, 2019 were treated with ventriculoperitoneal shunt (VPS). They were divided into two groups by randomized control method: 20 patients were treated with fixed pressure shunt (control group) and 20 patients were treated with adjustable shunt (experimental group). The improvement of clinical symptoms in the two groups was evaluated by analyzing 10 m walking test and Mini-Mental State Examination (MMSE). The improvement of cerebral ventricles was evaluated by Evans index (EI) and callosal angle (CA). The Modified Rankin Scale (MRS) and Glasgow Outcome Scale (GOS) were used to evaluate the prognosis of patients after treatment. The overall cognitive status of the two groups was assessed by the Beijing edition Montreal Cognitive Assessment Scale (MoCA). The executive function of the two groups was assessed by Frontal Assessment Battery (FAB) and Stroop Color and Word Test (SCWT). The complications of the two groups were observed and recorded. Results The test time and step number of 10 m walking test and MMSE scores of the experimental group were lower than those of the control group (P<0.05). The EI and CA in the experimental group were lower than those in the control group (P<0.05). The MRS score of the experimental group was lower than that of the control group, and the GOS score was higher than that of the control group (P<0.05). The total MoCA score, as well as the scores of visual space, attention and executive ability in the experimental group were higher than those in the control group (P<0.05). The scores of FAB and SCWT in the experimental group were higher than those in the control group (P<0.05). The incidence of postoperative complications in the experimental group was lower than that in the control group (10% vs. 30%, P<0.05). Conclusions Compared with the fixed pressure shunt, VPS with adjustable shunt is more effective in the treatment of INPH, with lower incidence of complications.