Shunting of the over 80s in normal pressure hydrocephalus

Abstract

Our data supports the assertion that, with proper patient selection, shunting of the over 80s with iNPH is a safe and effective procedure.

Negative predictors of shunt surgery outcome in normal pressure hydrocephalus

“…4 The most important explanation for this can be related to our long waiting time, as described above. 6 However, our improvement rate is in line with a large registry study from Sweden using a similar method for clinical evaluation, with 58% improvement. The mean age of the 273 patients included in our outcome analysis was 75 years (SD = 7), compared with 71 years (SD = 4) in the review mentioned above.…”

“…4 In contrast to our results, Thompson et al reported that 83% of their patients over 80 years improved. 6 However, our improvement rate is in line with a large registry study from Sweden using a similar method for clinical evaluation, with 58% improvement. 5 The length of follow-up in the present study was 12 months, which is in line with the majority of previous studies reporting outcome.…”

“…3 Implantation of a shunt reduces symptoms in approximately 80% of patients, but the majority of patients in recent studies were relatively young, with a mean age of 71 years. 6,7 The frequency of vascular comorbidities, such as hypertension or cerebrovascular disease, increases with age and is higher in patients with iNPH compared with controls. 6,7 The frequency of vascular comorbidities, such as hypertension or cerebrovascular disease, increases with age and is higher in patients with iNPH compared with controls.…”

“…while recent reports propose that age alone should not exclude patients from surgery 6,7. In a recent study by Sundström et al, patients over 80 years had significantly poorer outcome, measured using the modified Rankin scale, than younger patients, but there was no difference between age groups when measured using the iNPH scale or MMSE 5.…”

“…4 Whether or not these outcome rates hold for older patients is not fully clarified; there are reports that high age could be a negative predictor for shunt surgery outcome, 5 while more recent reports propose that age alone should not exclude patients from surgery. 6,7 The frequency of vascular comorbidities, such as hypertension or cerebrovascular disease, increases with age and is higher in patients Objectives: The prevalence of idiopathic normal pressure hydrocephalus (iNPH) and vascular comorbidity increases with age. It has not been clarified if high age and vascular disease are negative predictors of shunt surgery outcome in patients with iNPH.The aim of this study was to investigate the impact of high age and vascular comorbidity on outcome after shunt surgery in patients with iNPH.Methods: All 332 patients with iNPH who were treated with shunts between 2011 and 2015 at a single centre were consecutively included.…”