Assessing the predictive value of common gait measure for predicting falls in patients presenting with suspected normal pressure hydrocephalus

Abstract

Objective To assess the predictive value of common measures validated to predict falls in other geriatric populations in patients presenting with suspected Normal Pressure Hydrocephalus (NPH). Methods One hundred ninety-five patients over the age of 60 who received the Fall Risk Questionnaire were retrospectively recruited from the CSF Disorders clinic within the departments of Neurosurgery and Neurology. Multiple logistic regression was used to create a model to predict falls for patients with suspected NPH using common measures: Timed Up & Go, Dual Timed Up & Go, 10 Meter Walk, MiniBESTest, 6-Minute Walk, Lower Extremity Function (Mobility), Fall Risk Questionnaire, and Functional Activities Questionnaire. Results The Fall Risk Questionnaire and age were shown to be the best predictors of falls. The model was 95.92% (Positive predictive value: 83.93%) sensitive and 47.92% specific (Negative predictive value: 77.78%). Conclusion Patients presenting with suspected NPH are at an increased fall risk, 75% of the total patients and 89% of patients who responded to a temporary drain of CSF had at least one fall in the past 6 months. The Fall Risk Questionnaire and age were shown to be predictive of falls for patients with suspected NPH. The preliminary evidence indicates measures that have been validated to assess fall risk in other populations may not be valid for patients presenting with suspected NPH.

Risk assessment of accidental falls in patients taking trazodone, quetiapine, or risperidone for insomnia: A single‐center, case–control study

“…This study has several limitations. The risk factors we identified (triazolam use, age ≥ 70 years, male, length of stay ≥14 days, neurosurgery, and dementia) were consistent with previous reports 6,10–14,17 . However, our results differed for ophthalmology.…”

“…The following previously‐reported risk factors for accidental falls were ascertained: age ≥ 70 years, 6,10 male, 11 length of hospital stay ≥14 days, 12 and use of benzodiazepine receptor agonists 11 . Furthermore, the occurrence of the following was recorded: dementia, 13 stroke, 14 depression and diabetes, 15 Parkinson's disease, 14,16 and whether or not the patient was admitted any of the following departments: neurosurgery, 14,17 neurology, 14,16,18 cardiology, 19,20 ophthalmology, 20 and orthopedics 15,21 . Among benzodiazepine receptor agonists, we noted triazolam because of its reported high risk of falls 11 ; brotizolam and zolpidem were noted because of their high prescription volume at our hospital.…”

Differences in fall-related characteristics across cognitive disorders

“…Patients with NPH are at increased risk of falling, plausibly related to motor and cognitive impairments (Davis et al, 2021). Compared with healthy individuals, iNPH patients are 15 times more likely to fall, and experience higher fear of falling and lower confidence in avoiding falls (Larsson et al, 2021).…”

Longitudinal improvement in postural instability is distinct from gait in treated adult hydrocephalus

“…Ventriculoperitoneal shunting (VPS) has been shown to improve some gait parameters in patients with NPH for up to ten years post-operatively. [2][3][4][5] Balance dysfunction, or postural instability (PI), is another primary concern of patients with NPH, as they frequently present with falls, but little is known about the pathophysiology of PI or its response to VPS.…”