Clinical outcomes of normal pressure hydrocephalus in 116 patients: objective versus subjective assessment

Abstract

OBJECTIVEObjective assessment tests are commonly used to predict the response to ventriculoperitoneal (VP) shunting in patients with normal pressure hydrocephalus (NPH). Whether subjective reports of improvement after a lumbar drain (LD) trial can predict response to VP shunting remains controversial. The goal in this study was to compare clinical characteristics, complication rates, and shunt outcomes of objective and subjective LD responders who underwent VP shunt placement.METHODSThis was a retrospective review of patients with NPH who underwent VP shunt placement after clinical improvement with the LD trial. Patients who responded after the LD trial were subclassified into objective LD responders and subjective LD responders. Clinical characteristics, complication rates, and shunt outcomes between the 2 groups were compared with chi-square test of independence and t-test.RESULTSA total of 116 patients received a VP shunt; 75 were objective LD responders and 41 were subjective LD responders. There was no statistically significant difference in patient characteristics between the 2 groups, except for a shorter length of stay after LD trial seen with subjective responders. The complication rates after LD trial and VP shunting were not significantly different between the 2 groups. Similarly, there was no significant difference in shunt response between objective and subjective LD responders. The mean duration of follow-up was 1.73 years.CONCLUSIONSReports of subjective improvement after LD trial in patients with NPH can be a reliable predictor of shunt response. The currently used objective assessment scales may not be sensitive enough to detect subtle changes in symptomatology after LD trial.

Normal Pressure Hydrocephalus Associated with Alzheimer's Disease

“…In the elderly, aged ≥80 years, the estimated prevalence is ∼9% and, thus, far more frequent than in seniors < 80 years of age 3 . Early installation of a ventriculojugular or ventriculoperitoneal shunt has been reported to be an effective treatment 4–6 . However, the clinical appearance can vary among patients such that the typical triad is present in <60% of the patients 7,8 .…”

Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery

“…Although shunt implantation (either ventriculoperitoneal or lumboperitoneal shunt) ameliorates the motor and cognitive (partly) disabilities of NPH, the extent to which surgery mitigates individual symptoms still varies widely among these patients. Currently, physicians rely mostly on the different clinical features (symptoms) of patients for iNPH diagnosis and prediction of treatment responsiveness [40]. Brain scans may help the diagnosis of this disease and are usually employed to detect secondary structural lesions, such as neurodegenerative diseases, stroke, or traumatic brain injury, which exhibit a similar and ambiguous disease presentation [10].…”

Feasibility of action observation effect on gait and mobility in idiopathic normal pressure hydrocephalus patients

“…Prior to data collection, a research assistant who was a physiotherapist explained the details and demonstrated the timed up and go (TUG) test over the walkway. TUG is a widely used assessment tool to measure the effect of treatment on lower limb function and mobility [37][38][39] and proposed to use in diagnosis criteria 40 for iNPH. It demonstrated excellent reliability in elderly and chronic stroke.…”