Gait disturbance in normal pressure hydrocephalus: A clinical study

Bugalho, Paulo; Guimarães, João Tiago

doi:10.1016/j.parkreldis.2006.08.007

Cited by 52 publications

(54 citation statements)

References 12 publications

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“…This was not the case in our study, although duration was related to gait outcome in operated patients at trend level. Specific gait symptoms were not related to the outcome, which disagrees with the suggestion that the presence of frontal release signs represents worse postshunt prognosis, made by our group in a previous study 30 .…”

Section: Factors Influencing Cognitive Dysfunction Outcomecontrasting

confidence: 99%

Normal pressure hydrocephalus: a qualitative study on outcome

Bugalho

Alves

Ribeiro

2013

Arq. Neuro-Psiquiatr.

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Objective: To describe the natural history and shunt outcome in patients with normal pressure hydrocephalus (NPH) and the variables that influence both. Method: Motor and cognitive parameters of 35 patients with NPH, as well as shunt surgery status, were registered at two time points (T0 and T1). Results: Thirteen patients underwent shunt surgery. Favorable outcome in gait function occurred in 5 of 35 patients and was related to younger age, absence of cardiovascular risk factors (CVRF) and white matter lesions (WML), and shunt surgery. Cognitive outcome was favorable in 9 of 35 patients and associated with shunt surgery (trend level). Of the patients subjected to surgery, favorable outcome in motor function was related to younger age at T0 and absence of CVRF and WML (trend level). Conclusion: Shunt surgery had a significant effect on gait and less on cognition. Favorable outcome in gait was also associated with younger age and absence of CVRF and WML.Keywords: normal pressure hydrocephalus, natural history, shunt surgery. REsumo:Objetivo: Descrever a história natural e o prognóstico após cirurgia de derivação ventricular em doentes com hidrocefalia de pressão normal (HPN), e as variáveis que potencialmente os influenciam. Método: Foram registados os parâmetros motores e cognitivos de 35 doentes com HPN, assim como o status relativo a cirurgia, em dois pontos no tempo (T0 e T1). Resultados: Treze doentes foram submetidos a cirurgia. Melhoria na marcha ocorreu em 5 doentes e relacionou-se com idade mais jovem, ausência de factores de risco cardio-vascular (FRCV), ausência de lesões da substância branca (LSB) e colocação de derivação ventricular. Verificou-se melhoria cognitiva em 9 doentes, associada (p=0,05) com colocação de derivação ventricular. Em doentes submetidos a cirurgia, o prognóstico favorável a nível motor relacionou-se com idade mais jovem em T0, ausência de FRCV e de LSB. Conclusão: A cirurgia para colocação de derivação ventricular teve um efeito significativo sobre a marcha e menor na cognição. O prognóstico favorável na marcha parece também associar-se a idade mais jovem, a ausência de FRV e de LSB.Palavras-chave: hidrocefalia de pressão normal, história natural, cirurgia de derivação ventriculo-peritoneal.Normal pressure hydrocephalus (NPH) was first des cri bed by Hakim and Adams as a syndrome that consisted of the triad of gait dysfunction, dementia, and urinary in continence, was associated with ventricular dilation, was potentially treatable by cerebrospinal fluid (CSF) surgical derivation (shunt surgery) 1

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Section: Factors Influencing Cognitive Dysfunction Outcomecontrasting

confidence: 99%

Normal pressure hydrocephalus: a qualitative study on outcome

Bugalho

Alves

Ribeiro

2013

Arq. Neuro-Psiquiatr.

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“…A score of higher than 1 was considered impaired postural reflexes; SD: standard deviation; ** value for females was used; Gait cadence: number of steps per minute; Reference normality values of the preceding decade were used for patients older than 80 years. study 14 , our results indicate that parkinsonian signs are unusual. A possible explanation for these different outcomes was that the aforementioned authors did not discuss whether patients with "probable" and "possible" INPH were included in their criteria.…”

Section: Hesitant Gaitsupporting

confidence: 46%

“…However, consistent with findings from another Table 1. Classification of gait and posture 4,14,15,16,17,18,19,20 . Characterized by at least one episode of sudden deceleration or a break (feet almost stuck to floor) in gait during free walking.…”

Section: Discussionmentioning

confidence: 99%

“…This was always done by two physicians (the first author and another member of the medical staff in the neurology department). Criteria used to evaluate gait and posture 4,14,15,16,17,18,19,20 are described in Table 1. The patient's gait speed was considered reduced when the time spent to traverse 10 m was greater than 11 seconds (s).…”

Section: Gait Analysismentioning

confidence: 99%

“…An improvement greater than 9% after the CSF-TT was considered the cut-off value for a gain in gait velocity. The following formula was used in percentages to evaluate if there was improvement in gait speed with the TT: 100 X (result before LP -best result after LP) / result before LP 14 .…”

Section: Gait Analysismentioning

confidence: 99%

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Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test

Souza

Rocha

Martins

et al. 2018

Arq. Neuro-Psiquiatr.

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Normal pressure hydrocephalus (NPH), described by Hakim and Adams in 1965, is characterized by gait apraxia, urinary incontinence, and dementia. It is associated with normal cerebrospinal fluid (CSF) pressure and ventricular dilation that cannot be attributed to cerebral atrophy. Objectives: To evaluate gait characteristics in patients with idiopathic NPH and investigate the effect of the CSF tap test (CSF-TT) on gait. Methods: Twenty-five patients diagnosed with probable idiopathic NPH were submitted to the CSF-TT. The procedure aimed to achieve changes in gait parameters. Results: Fifteen gait parameters were assessed before and after the CSF-TT. Five showed a statistically significant improvement (p < 0.05): walking speed (p < 0.001), cadence (p < 0.001), step length (p < 0.001), en bloc turning (p = 0.001), and step height (p = 0.004). Conclusion: This study demonstrated that gait speed was the most responsive parameter to the CSF-TT, followed by cadence, step length, en bloc turning, and step height.

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Clinical Features of Idiopathic Normal Pressure Hydrocephalus: Critical Review of Objective Findings

Bluett¹,

Ash

Farheen

et al. 2022

Movement Disord Clin Pract

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Background Idiopathic normal pressure hydrocephalus (iNPH) is characterized by the classic clinical triad of gait, cognitive, and urinary dysfunction, albeit incomplete in a relevant proportion of patients. The clinical findings and evolution of these symptoms have been variably defined in the literature. Objectives To evaluate how the phenomenology has been defined, assessed, and reported, we performed a critical review of the existing literature discussing the phenomenology of iNPH. The review also identified the instrumental tests most frequently used and the evolution of clinical and radiologic findings. Methods The review was divided into 3 sections based on gait, cognitive, and urinary dysfunction. Each section performed a literature search using the terms “idiopathic normal pressure hydrocephalus” (iNPH), with additional search terms used by each section separately. The number of articles screened, duplicates, those meeting the inclusion criteria, and the number of articles excluded were recorded. Findings were subsequently tallied and analyzed. Results A total of 1716 articles with the aforementioned search criteria were identified by the 3 groups. A total of 81 full‐text articles were reviewed after the elimination of duplicates, articles that did not discuss phenomenological findings or instrumental testing of participants with iNPH prior to surgery, and articles with fewer than 10 participants. Conclusions “Wide‐based gait” was the most common gait dysfunction identified. Cognitive testing varied significantly across articles, and ultimately a specific cognitive profile was not identified. Urodynamic testing found detrusor overactivity and “overactive bladder” as the most common symptom of urinary dysfunction.

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Gait disturbance in normal pressure hydrocephalus: A clinical study

Cited by 52 publications

References 12 publications

Normal pressure hydrocephalus: a qualitative study on outcome

Normal pressure hydrocephalus: a qualitative study on outcome

Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test

Clinical Features of Idiopathic Normal Pressure Hydrocephalus: Critical Review of Objective Findings

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