Waiting time for surgery influences the outcome in idiopathic normal pressure hydrocephalus — a population-based study

Chidiac, Christine; Sundström, Nina; Tullberg, Mats; Arvidsson, Lisa; Olivecrona, Magnus

doi:10.1007/s00701-021-05085-7

Cited by 10 publications

(6 citation statements)

References 24 publications

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“…This delay was longer than that of SINPHONI-2. Regarding the waiting time for surgery in patients with iNPH, the outcomes were compared between the three groups of < 3 months, < 6 months, and more 26 . The highest outcome was observed at 12 months in the group with a waiting time of < 3 months.…”

Section: Discussionmentioning

confidence: 99%

Association of gait and cognition after surgery in patients with idiopathic normal pressure hydrocephalus

Ishikawa,

Mori

2023

Sci Rep

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Idiopathic normal pressure hydrocephalus (iNPH) is a treatable disease in older adults. The association between gait and cognition has recently become a topic of interest. Sequential changes in this association were investigated in patients with iNPH using a newly developed statistical method. Data were extracted from the SINPHONI-2 multicenter study on iNPH. Fifty patients who underwent shunt surgery were included in this study. Gait and cognition were assessed using the Timed Up and Go (TUG) and Mini-Mental State Examination (MMSE) tests. In addition to the MMSE total score, changes in the sub-item scores were examined. The ordinal sub-items of the MMSE are usually treated as continuous or categorical; however, both are unsuitable. An ordinal smoothing penalty with a generalized additive model enables precise statistical inference of ordinal and binary predictors. The TUG time improved significantly at 3, 6, and 12 months after surgery. The MMSE total scores increased without statistical significance. Preoperatively, there was no association between TUG time and MMSE sub-items. At 3 months, the “Registration,” ”3-step command,” “Read,” and “Copy” sub-items were statistically significant. The number of significant sub-items increased after 12 months. Thus, the association between gait and cognition gradually increased after surgery in patients with iNPH.

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Section: Discussionmentioning

confidence: 99%

Association of gait and cognition after surgery in patients with idiopathic normal pressure hydrocephalus

Ishikawa,

Mori

2023

Sci Rep

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“…Patients were defined as “Improved” if postoperatively their iNPH scale had improved by at least five points, otherwise they were considered “Non-improved” [ 10 ]. The threshold of five points for clinically relevant improvement has been used in previous studies [ 3 , 11 – 14 ], originally based on clinical experience. The iNPH scale score is derived from a range of standardized quantitative tests and qualitative scales, measured by three different examiners of the three different professions (physician, physiotherapist, neuropsychologist).…”

Section: Methodsmentioning

confidence: 99%

Symptoms and signs did not predict outcome after surgery: a prospective study of 143 patients with idiopathic normal pressure hydrocephalus

Andrén,

Wikkelsø,

Laurell

et al. 2024

J Neurol

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Objective To determine the utility of symptoms, signs, comorbidities and background variables for the prediction of outcome of treatment in iNPH. Methods A prospective observational study of consecutively included iNPH patients, who underwent neurological, physiotherapeutic and neuropsychological assessments before and after shunt surgery. The primary outcome measure was the total change on the iNPH scale, and patients were defined as improved postoperatively if they had improved by at least five points on that scale. Results 143 iNPH patients were included, and 73% of those were improved after surgery. None of the examined symptoms or signs could predict which patients would improve after shunt surgery. A dominant subjective complaint of memory problems at baseline was predictive of non-improvement. The reported comorbidities, duration of symptoms and BMI were the same in improved and non-improved patients. Each of the symptom domains (gait, neuropsychology, balance, and continence) as well as the total iNPH scale score improved significantly (from median 53 to 69, p < 0.001). The proportions of patients with shuffling gait, broad-based gait, paratonic rigidity and retropulsion all decreased significantly. Discussion This study confirms that the recorded clinical signs, symptoms, and impairments in the adopted clinical tests are characteristic findings in iNPH, based on that most of them improved after shunt surgery. However, our clinical data did not enable predictions of whether patients would respond to shunt surgery, indicating that the phenotype is unrelated to the reversibility of the iNPH state and should mainly support diagnosis. Absence of specific signs should not be used to exclude patients from treatment.

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“…Typically, adults aged 65 years or older are affected by iNPH with an estimated prevalence of 1.4-3.7% that increases with age [7,8]. Clearance of excess cerebrospinal fluid (CSF) with shunting is an effective treatment and waiting-time to surgery can negatively impact the outcome; hence, timely interventions are important [9,10].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal neuropsychological trajectories in idiopathic normal pressure hydrocephalus: a population–based study

et al. 2023

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Background Idiopathic normal pressure hydrocephalus (iNPH) is a progressive syndrome affecting gait, incontinence, and cognition in a significant number of older adults. Still, prospective studies on early development of symptoms are scarce. Aim To investigate how neuropsychological functions develop before and in already diagnosed iNPH over a two-year period in a population-based material. Method A sample of 104 participants (median [IQR] 75 [72–80] years old) from the general population underwent CT-imaging and clinical assessment at baseline and follow-up. We used the iNPH symptom scale covering four domains (Neuropsychology, Gait, Balance, Incontinence) and additional tests of executive functions. Morphological signs were rated with the iNPH Radscale. Non-parametric statistics with Bonferroni corrections and a significance-level of p < 0.05 were used. Results Median (IQR) time to follow-up was 25 (23–26) months. Effect size (ES) for individuals who developed iNPH (n = 8) showed a large (ES r = -0.55) decline in the Gait domain and on the Radscale (ES r = -0.60), with a medium deterioration in declarative memory (ES r = -0.37). Those having iNPH at baseline (n = 12) performed worse on one executive sub-function i.e., shifting (p = 0.045). Conclusion Besides deterioration in gait and radiology, our results suggest that a neuropsychological trajectory for those developing iNPH includes a reduction in declarative memory. Executive dysfunction was limited to those already having iNPH at baseline. These findings could suggest that memory impairments are included in the early development of iNPH.

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Waiting time for surgery influences the outcome in idiopathic normal pressure hydrocephalus — a population-based study

Cited by 10 publications

References 24 publications

Association of gait and cognition after surgery in patients with idiopathic normal pressure hydrocephalus

Association of gait and cognition after surgery in patients with idiopathic normal pressure hydrocephalus

Symptoms and signs did not predict outcome after surgery: a prospective study of 143 patients with idiopathic normal pressure hydrocephalus

Longitudinal neuropsychological trajectories in idiopathic normal pressure hydrocephalus: a population–based study

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