The benefit of delayed reassessment post high-volume CSF removal in the diagnosis of shunt-responsive idiopathic normal-pressure hydrocephalus

5-Year health-related quality of life outcome in patients with idiopathic normal pressure hydrocephalus

“…The Cox Proportional-Hazards Model was conducted for mortality analysis. The variable selection of statistical models was based on clinical significance and previously established predictors (Table 1) [1][2][3][4][5][6][7]. Due to drop-out/missing data, additional steps to detect signs of attrition bias were taken: when all variables (including outcome indicators) were analyzed at the same time to detect systematic tendencies in missing data, no significant tendencies were observed (Little's Missing Completely at Random-test; p = 0.067).…”

“…Seven studies have evaluated health-related quality of life (HRQoL) in patients with idiopathic normal pressure hydrocephalus (iNPH) prior to and after cerebrospinal fluid (CSF) shunting (Table 1) [1][2][3][4][5][6][7]. A significant heterogeneity exists among the published studies: six different HRQoL instruments were applied, follow-up times ranged from 3 to 45 months and there was a lack of studies replicating and confirming previous findings (Table 1) [1][2][3][4][5][6][7]. Factors associated with poorer HRQoL outcome in iNPH in uni-or multivariate analyses have been identified: depressive symptoms [2], larger comorbidity burden [2,4,6], obesity [4], hyperlipidemia [2], severity of gait impairment [2], post-operative complications [5] and beta amyloid (Aβ) or hyperphosphorylated tau (HPτ) pathology in the frontal cortical biopsy [4].…”

“…Factors associated with poorer HRQoL outcome in iNPH in uni-or multivariate analyses have been identified: depressive symptoms [2], larger comorbidity burden [2,4,6], obesity [4], hyperlipidemia [2], severity of gait impairment [2], post-operative complications [5] and beta amyloid (Aβ) or hyperphosphorylated tau (HPτ) pathology in the frontal cortical biopsy [4]. While five out of seven (71%) studies observed significant HRQoL improvement following CSF shunting, only three studies reported HRQoL improvement rates [2,4,5], that ranged from 43 to 83% (Table 1) [1][2][3][4][5][6][7]. These three studies were also the only ones having controls from the general population, two of which compared HRQoL between their cohort and controls [2,5].…”

“…Seven studies have evaluated health-related quality of life (HRQoL) in patients with idiopathic normal pressure hydrocephalus (iNPH) prior to and after cerebrospinal fluid (CSF) shunting (Table 1 ) [ 1 – 7 ]. A significant heterogeneity exists among the published studies: six different HRQoL instruments were applied, follow-up times ranged from 3 to 45 months and there was a lack of studies replicating and confirming previous findings (Table 1 ) [ 1 – 7 ].…”

Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus

“…In the present study, a clinical improvement in gait speed with a small effect was found in most (37.3%), a moderate effect was found in some (7.8%), and no large effect was found in individuals with iNPH who responded to the intervention. These different response levels in the tap test responders may be related to the duration of the assessment 53 and may be important in predicting shunt surgery success in the future. However, because of these MCIC criteria, the number of individuals who responded to the intervention was less than half (45.1%), unlike the results reported in a previous study where people who had a positive response ranged from 67‒86 % of participants 19 , 46 , 54 .…”