Multimodal analysis to predict shunt surgery outcome of 284 patients with suspected idiopathic normal pressure hydrocephalus

Abstract

Prediction of the treatment response in iNPH is challenging even with our extensive dataset and refined analysis. Further research of biomarkers and indicators predicting shunt responsiveness is still needed.

Cerebrospinal fluid biomarkers in idiopathic normal pressure hydrocephalus

“…Определение биомаркеров может использоваться в дополнение к МРТ головного мозга и инвазивным методам для повышения точности диагностики. Также некоторые биомаркеры и их соотношения могут быть использованы для прогнозирования эффективности шунтирующей опера-ции, но при условии их комплексной оценки, так как ни один биомаркер не обладает абсолютной прогностической точностью в отношении ответа на шунтирование [43,44].…”

Predicting Development of Alzheimer’s Disease in Patients with Shunted Idiopathic Normal Pressure Hydrocephalus

“…has not been the case [3,26], which may be result of the limited follow-up time of 3 months at outpatient clinic. Although MTA was not measured for the whole cohort (n = 119), we consider that the baseline visual assessment of MTA can be used in conjunction with other factors to predict later development of clinical AD.…”

“…Patients shunted for iNPH were included in the analysis, but those with iNPH and comorbid clinical AD at baseline were excluded from the prognostication analysis ( Figure 1). Selection for shunt surgery was done with 24-h intraventricular pressure (IVP) monitoring until the end of 2010 with indications for shunt: 1) a basal ICP above 10 mmHg; or 2) the presence of any A waves or more than 30% B waves during the 24-hour ICP monitoring [3,14,21]. Since 2011, a three-step protocol was used for shunt surgery selection: first a lumbar CSF removal of 20 ml (tap test) was performed for all patients, and 20 % improvement in gait speed was considered positive response; patients with negative tap test underwent a lumbar infusion test, where conductance of 10 or less was considered pathological [22]; and those with negative result both in tap test and infusion test were shunted based on 24-h IVP monitoring as described above.…”

“…Apart from other neurodegenerative diseases, symptoms of iNPH can be alleviated with cerebrospinal fluid (CSF) diversion, although successful selection of patients for shunt treatment has proven to be difficult [3][4][5]. Patients diagnosed with iNPH have shown to often have pathological changes related to Alzheimer's disease (AD) [6][7][8][9][10][11][12], which has been linked to later development of AD and dementia [13,14].…”

Need of informatics in designing interoperable clinical registries

“…"(1). Clinical registries have been designed for various purposes such as: studying the natural history of disease (2), analyzing clinical outcome of surgery/treatment (3), comparing different treatment methods (4), and measuring quality of care (5). However many clinical registries have been designed successfully and there are user guides, aimed to assist with designing registries (1), but still there are some caveats on designing clinical registries such as: interoperability.…”