Survival in treated idiopathic normal pressure hydrocephalus

Abstract

Objective To describe survival and causes of death in 979 treated iNPH patients from the Swedish Hydrocephalus Quality Registry (SHQR), and to examine the influence of comorbidities, symptom severity and postoperative outcome. Methods All 979 patients operated for iNPH 2004–2011 and registered in the SHQR were included. A matched control group of 4890 persons from the general population was selected by Statistics Sweden. Data from the Swedish Cause of Death Registry was obtained for patients and controls. Results At a median 5.9 (IQR 4.2–8.1) year follow-up, 37% of the iNPH patients and 23% of the controls had died. Mortality was increased in iNPH patients by a hazard ratio of 1.81, 95% CI 1.61–2.04, p < 0.001. More pronounced symptoms in the preoperative ordinal gait scale and the Mini-mental State Examination were the most important independent predictors of mortality along with the prevalence of heart disease. Patients who improved in both the gait scale and in the modified Rankin Scale postoperatively (n = 144) had a similar survival as the general population (p = 0.391). Deaths due to cerebrovascular disease or dementia were more common in iNPH patients, while more controls died because of neoplasms or disorders of the circulatory system. Conclusions Mortality in operated iNPH patients is 1.8 times increased compared to the general population, a lower figure than previously reported. The survival of iNPH patients who improve in gait and functional independence is similar to that of the general population, indicating that shunt surgery for iNPH, besides improving symptoms and signs, can normalize survival.

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

“…There were proportionally more deaths in those presenting Alzheimer’s disease (AD)-related pathology and in those with an increased comorbidity burden. While the comorbidity burden in our study is in line with a recent Swedish study [ 18 ], it is notable that even in Finnish cohorts with similar follow-up periods, AD-related pathology has not always been associated with increased mortality [ 25 ]. This difference might be due to the used model, as the previous study did not take into account the comorbidity burden in their model [ 25 ].…”

“…The death certificates were obtained from the database of Statistics Finland. Causes of death were classified using ICD-10 diagnosis codes (International Statistical Classification of Diseases and Related Health Problems 10th revision) and were grouped according to a larger iNPH survival study [ 18 ].…”

Dynamic functional networks in idiopathic normal pressure hydrocephalus: Alterations and reversibility byCSFtap test

“…Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait, cognitive and urinary impairments with ventriculomegaly at brain imaging (Gallia, Rigamonti, & Williams, 2006; Relkin, Marmarou, Klinge, Bergsneider, & Black, 2005; Williams & Malm, 2016). Symptoms can be partially reverted by CSF flow diversion with invasive shunt neurosurgery, making iNPH the leading cause of reversible dementia (Andrén et al, 2020; Halperin, Kurlan, Schwalb, & Cusimano, 2015; Todisco et al, 2020; Wallenstein & McKhann, 2010). The prevalence of iNPH is estimated at 6% in adults older than 80 years (Jaraj et al, 2014).…”

Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus

“…The long-term effect in shunt responders has been described as encouraging with regard to survival and quality of life. 21,55,58,59 Nevertheless, although some studies showed sustained and beneficial improvement of shunting in more than 50% of patients after 5-year follow-up, 23,60 other studies demonstrated loss of benefit in a variable portion of patients. 2 The reasons for these discrepancies are probably related to the syndromic heterogeneity of iNPH.…”