Objectives: The aim of this study was to determine the prevalence of idiopathic normal-pressure hydrocephalus (iNPH) in elderly persons in a large population-based sample using radiologic and clinical examinations. Methods:We examined representative elderly populations aged 70 years and older that had undergone neuropsychiatric evaluations and CT of the brain between 1986 and 2000 (n 5 1,238). Gait was evaluated by clinical examination and history of walking difficulty. Cognitive function was evaluated with the Mini-Mental State Examination and urinary incontinence by selfreport. iNPH was diagnosed in concordance with the American-European iNPH guidelines. Exclusion criteria were history of meningitis, severe head trauma, and subarachnoid hemorrhage.Results: The prevalence of probable iNPH was 0.2% in those aged 70-79 years (n 5 2) and 5.9%(n 5 24) in those aged 80 years and older, with no difference between men and women. Only 2 of these persons had been treated for iNPH. Hydrocephalic ventricular enlargement, i.e., a CT image consistent with NPH, was found in 56 persons (4.5%). An Evans Index .0.3 was found in 256 (20.7%) and occluded sulci at the high convexity in 67 persons (5.4%). All of these findings were more common in the older age groups. The number of elderly and people with dementia is increasing in most parts of the world.1 It is therefore important to learn more about the prevalence of treatable causes of dementia. Idiopathic normal-pressure hydrocephalus (iNPH) is a treatable neurologic disorder first described by Salomón Hakim in 1965.2 iNPH is characterized by gait and balance impairment, cognitive deterioration, and urinary incontinence, and radiologically by a communicating ventricular enlargement.3 Treatment by diversion of CSF to the peritoneal cavity or heart is successful in reversing symptoms in more than 80% of the patients. 4 iNPH is thus one of the few causes of reversible dementia, but it is still underdiagnosed. 5,6 The prevalence of iNPH in selected populations and in community-based studies on young elderly varies between 0.1% and 2.9%.5,7-10 However, few large population-based studies have investigated the prevalence of iNPH, and most included few persons older than 80 years. Thus, the prevalence still has to be examined in population-based studies including many persons older than 80 years.The aim of this study was to determine the prevalence of iNPH by examining CT images of the brain and clinical signs of iNPH in a large representative elderly population.METHODS Study population. Between 1986 and 2000, studies on representative elderly populations in Gothenburg, Sweden, were conducted using identical examinations (including neuropsychiatric examinations and key informant interviews) at each
Objective: We examined clinical and imaging findings of suspected idiopathic normal pressure hydrocephalus (iNPH) in relation to vascular risk factors and white matter lesions (WMLs), using a nested case-control design in a representative, population-based sample.Methods: From a population-based sample, 1,235 persons aged 70 years or older were examined with CT of the brain between 1986 and 2000. We identified 55 persons with hydrocephalic ventricular enlargement, i.e., radiologic findings consistent with iNPH. Among these, 26 had clinical signs that fulfilled international guideline criteria for probable iNPH. These cases were labeled suspected iNPH. Each case was matched to 5 controls from the same sample, based on age, sex, and study cohort. Data on risk factors were obtained from clinical examinations and the Swedish Hospital Discharge Register. History of hypertension, diabetes mellitus (DM), smoking, overweight, history of coronary artery disease, stroke/TIA, and WMLs on CT were examined. Risk factors associated with iNPH with a p value ,0.1 in x 2 tests were included in conditional logistic regression models. Idiopathic normal pressure hydrocephalus (iNPH) is probably more common than previously supposed. We have recently reported that 5.9% of persons older than 80 years have this disorder. 1 Treatment with shunt surgery improves symptoms in more than 80% of patients. 2 Despite this, iNPH is underdiagnosed and undertreated.1,3 Furthermore, little is known about the underlying disease mechanisms. It is important to learn more about risk factors for the disease in order to understand pathophysiologic mechanisms and suggest preventive measures. Vascular risk factors, such as hypertension, diabetes, and ischemic heart disease, have previously been associated with iNPH in hospital-based, case-control studies.4-9 Also, cerebral white matter lesions (WMLs), which are associated with small vessel disease and white matter ischemia, 10 are common in iNPH. 11,12 It has therefore been suggested that vascular mechanisms may be related to the development of iNPH. However, previous studies on risk factors have not been population-based. Furthermore, there are no previous epidemiologic investigations regarding WMLs in iNPH.
To investigate the prevalence of intracranial arachnoid cysts in a large population-based sample. We also aimed to assess the association between arachnoid cysts and cognitive impairment, depression, epilepsy, headache, dizziness, previous head trauma, hip fractures, and mortality. A population-based cohort and nested case-control study. The sample comprised representative populations (n = 1235) aged ≥ 70 years. All participants underwent baseline neuropsychiatric examinations, including computed tomography (CT) of the brain, between 1986 and 2000. All CT scans were examined for arachnoid cysts. Headache, dizziness, history of head trauma, dementia, depression, epilepsy, and hip fracture were assessed using data from clinical examinations, interviews and the Swedish hospital discharge register. Cognition was assessed using the Mini-Mental Status Examination, and depressive symptoms using the Montgomery-Åsberg Depression Rating Scale. Date of death was obtained from the National Swedish Death Registry. The prevalence of arachnoid cysts was 2.3 % (n = 29), with no significant difference between men and women. Probands with and without cysts had the same frequency of headache, dizziness, previous head trauma, cognitive impairment, and depressive symptoms. Furthermore, there were no differences regarding the prevalence of dementia, depression, epilepsy, or previous hip fracture. Arachnoid cysts were not associated with increased mortality. Arachnoid cysts are common incidental finding, with the same rate in men and women, and are probably asymptomatic. The lack of relation with symptoms like headache, dizziness and cognitive impairment suggest caution in ascribing symptoms to incidentally discovered arachnoid cysts and a restrictive attitude to treatment.
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