Improvement in social function and health-related quality of life after shunt surgery for idiopathic normal-pressure hydrocephalus

Abstract

Object To investigate the impact of shunt surgery on the activity, participation, autonomy, and health-related quality of life (HRQOL) of patients with idiopathic normal-pressure hydrocephalus (iNPH) as well as the effect on caregiver burden. Methods Thirty-seven patients (median age 70 years, range 50–89 years) with iNPH were evaluated before and 6 months after surgery. Symptoms and signs were assessed by the iNPH scale, activities of daily living (ADL) with the Functional Independence Measure (FIM) and Assessment of Motor and Process Skills (AMPS), autonomy and participation with Impact on Participation and Autonomy (IPA), and caregiver burden with the Caregiver Burden Scale (CBS). HRQOL was evaluated with the EQ-5D (EuroQol Group–5 Dimension health survey). Results Twenty-four patients (65%) improved clinically (iNPH scale score) and 31 (86%) improved their HRQOL after surgery, almost to the same level as found in the normal population. The patients became more independent in physical and cognitive activities, and participation and autonomy improved. The caregiver burden was decreased among caregivers to male patients but remained unchanged on the overall group level. Conclusions After shunt surgery, patients with iNPH showed improvement in most aspects of social life, they became more independent, and their quality of life returned to nearly normal.

Health‐related quality‐of‐life outcome in patients with idiopathic normal‐pressure hydrocephalus – a 1‐year follow‐up study

“…There is a large contrast between our study and the literature [11][12][13][14] when it comes to favorable outcome rate, and this might be due to the differences in the methods for assessing and classifying the outcome. In our study the HRQoL outcome was classified as 'unfavorable' if the HRQoL deteriorated or remained the same.…”

Health‐related quality of life in patients with idiopathic normal pressure hydrocephalus

“…The HRQoL of iNPH patients has been measured previously using SF‐36 and QoL‐10; however, it was not stated whether any secondary NPH patients were included in their study group . In addition, the brief QoL inventory SF‐12 and EQ‐5D have been used to estimate HRQoL at baseline and after shunt surgery in iNPH patients.…”

“…Only few studies have measured HRQoL amongst iNPH patients . Our primary aim was to compare the HRQoL of iNPH patients with that of an age‐ and gender‐matched sample of the general population.…”

Why Does the Health-Related Quality of Life in Idiopathic Normal-Pressure Hydrocephalus Fail to Improve Despite the Favorable Clinical Outcome?

“…**Diagnostic criteria by Relkin et al 2005. between the PRO and PROM rationalizes, in its very essence, the use of both measurements and elucidates the limitations if used alone. [5][6][7][8][9]30 An exciting finding was that neither the absence of Abeta and HPtau pathology in the frontal cortical biopsy (indicating the absence of comorbid Alzheimer disease pathology) nor a better cognitive function decreased the likelihood of discrepancy. However, our results should be interpreted cautiously, as generic utility measurements, such as the 15D instrument, might have limited sensitivity to detect health status changes in persons with cognitive impairment.…”

“…4 In contrast, PROs, such as Health-Related Quality of Life (HRQoL), may appreciate aspects not captured by ClinROs. [5][6][7][8][9] Recently, we published a prospective 1-year follow-up study of HRQoL outcome in patients with idiopathic normal-pressure hydrocephalus (iNPH), 9 a progressing condition of elderly patients that characteristically impairs their gait, cognition, and urinary continence. [10][11][12] The so-far unknown origin has been contemplated to cause various abnormalities in the cerebrospinal fluid (CSF) physiology and hydrodynamics, which ultimately lead to the symptoms and signs observed in patients with iNPH.…”