Estimated incidence of normal-pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The primary objective of this study was to estimate the prevalence of idiopathic normal-pressure hydrocephalus (NPH), both diagnosed and undiagnosed, among residents of assisted-living and extended-care facilities, by using a practical screening tool. A secondary objective was to evaluate prospectively the diagnosis and outcome of surgical treatment in a subset of patients residing in healthcare facilities who were at risk for idiopathic NPH.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A retrospective chart analysis was performed using the medical records from four nursing homes. The final analysis included 147 patient records. Symptomatology and comorbidity were evaluated, as was the ability to perform activities of daily living. In a subset of 17 patients residing in healthcare facilities, the authors applied a standard idiopathic NPH diagnostic and management protocol and followed up the patients 1 year after treatment.</jats:p> <jats:p>The estimated incidence of suspected idiopathic NPH among all patients in the retrospective survey ranged from 9 to 14%, depending on the diagnostic criteria used. Among the cohort of 17 patients available for an in-hospital study and 1-year follow up, 11 received shunts and seven of these showed either transient or sustained improvement.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>A valid and practical diagnostic method is needed to identify idiopathic NPH accurately before admitting patients to a healthcare facility. Data from a prospective study of 17 patients residing in healthcare facilities indicated that supplementary tests remain predictive of a positive response to shunt insertion but cannot predict whether a favorable outcome will be sustained in a population of patients who have been confined to a wheelchair for a prolonged period of time. This finding supports the notion of a finite window of opportunity for successful treatment of idiopathic NPH and the imperativeness of an early diagnosis.</jats:p></jats:sec>

Development of hydrocephalus and classical hypothesis of cerebrospinal fluid hydrodynamics: Facts and illusions

“…A special chronic type of communicating hydrocephalus is a normal-pressure hydrocephalus described as a syndrome of ventricular enlargement which occurs in the absence of elevated CSF pressure and is accompanied with gait disturbance, dementia and incontinence (Bergsneider et al, 2005;Hakim and Adams, 1965;Marmarou et al, 2007;Vanneste et al, 1993). Despite the clinical problems indicated in the guidelines for diagnosing and treating such patients, the main interest of this article is to discuss the nature of its development.…”

Outcome of modern shunt therapy in patients with idiopathic normal pressure hydrocephalus 6 years postoperatively

“…3 Currently, the estimated number of undetected cases of iNPH may be higher than expected. Approximately 9%-14% of nursing home inhabitants show symptoms of iNPH, 19 and a further increase in cases can be expected given the aging demographic of the population. The economic cost of a comparable dementia disease, such as Alzheimer's disease, is around €43,765 per patient per year.…”

Timing of surgical treatment for idiopathic normal pressure hydrocephalus: association between treatment delay and reduced short-term benefit

“…23 However, given the significant number of patients who do not show improvement postoperatively, efforts have been taken to better identify potential responders to treatment and potential prognostic predictors that may be controlled. 10 The duration of symptoms prior to surgical treatment is suggested to be a potential predictor of outcomes, with delayed treatment potentially decreasing treatment response. A retrospective study of 132 patients found duration of symptoms and gait as the primary symptom as the only independent predictors of outcomes in the surgical treatment of iNPH.…”

“…Therefore, the extent and ways in which delayed treatment influences postoperative clinical outcomes remain to be elucidated. Given a prevalence of as much as 1.4% in the elderly adult population, 12,21 and 9%-14% in the assisted-living population, 10,12 it is important to determine to what degree more aggressive identification of iNPH cases for early intervention may prevent morbidity and mortality. The objective of this study was to provide more clarity to these questions and to determine whether the duration of preoperative symptoms alters postoperative outcomes in patients treated for iNPH.…”