Why Does the Health-Related Quality of Life in Idiopathic Normal-Pressure Hydrocephalus Fail to Improve Despite the Favorable Clinical Outcome?

Junkkari, Antti; Roine, Risto P.; Luikku, Antti; Rauramaa, Tuomas; Sintonen, Harri; Nerg, Ossi; Koivisto, Anne M.; Häyrinen, A.; Viinamäki, Heimo; Jääskeläinen, Juha E.; Leinonen, Ville

doi:10.1016/j.wneu.2017.08.170

Cited by 7 publications

(3 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While the gait performance is, by far, the most objective measure for outcome assessment in iNPH, other outcome indicators should accompany it. Performance in activities of daily living and patient reported outcome measures might enhance clinical evaluation in this regard [10, 33], but should not be used alone [33]. Unfortunately, we do not have follow-up information regarding the 14 probable or possible iNPH patients that were not shunted (Fig.…”

Section: Discussionmentioning

confidence: 99%

The Kuopio idiopathic normal pressure hydrocephalus protocol: initial outcome of 175 patients

Junkkari

Luikku

Danner

et al. 2019

Fluids Barriers CNS

Self Cite

View full text Add to dashboard Cite

Background The Kuopio University Hospital (KUH) idiopathic normal pressure hydrocephalus (iNPH) cerebrospinal fluid (CSF) shunting protocol is described together with the initial outcomes of 175 patients with probable iNPH treated according to this protocol from a defined population. Our secondary aim was to display the variety of differential diagnoses referred to the KUH iNPH outpatient clinic from 2010 until 2017. Methods Patients were divided into four groups according to the prognostic tests: tap test (positive or negative) and infusion test (positive or negative). The short-term outcome was compared between groups. The 3-month outcome following shunt surgery was assessed by measuring gait speed improvement, using a 12-point iNPH grading scale (iNPHGS) and the 15D instrument. Results From 341 patients suspected of iNPH, 88 patients were excluded from further research mostly due to deviation from the protocol’s gait assessment guidelines. Hence 253 patients with suspected iNPH were included in the study, 177/253 (70%) of whom were treated with a CSF shunt. A favorable clinical outcome following surgery was observed in 79–93% of patients depending on the prognostic group. A moderate association (Cramer’s V = 0.32) was found between the gait speed improvement rate and the prognostic group (X 2 , p = 0.003). Patients with a positive tap test had the highest gait speed improvement rate (75%). In addition, an improvement in walking speed was observed in 4/11 patients who had both a negative tap test and a negative infusion test. Other outcome measures did not differ between the prognostic groups. Conditions other than iNPH were found in 25% of the patients referred to iNPH outpatient clinic, with the most prevalent being Alzheimer’s disease. Conclusions Our results emphasize the importance of a systematic diagnostic and prognostic workup especially in cases with an atypical presentation of iNPH. Additional diagnostic testing may be required, but should not delay adequate care. Active surgical treatment is recommended in patients with a high clinical probability of iNPH. Other neurological conditions contributed to most of the non iNPH diagnoses. Electronic supplementary material The online version of this article (10.1186/s12987-019-0142-9) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

The Kuopio idiopathic normal pressure hydrocephalus protocol: initial outcome of 175 patients

Junkkari

Luikku

Danner

et al. 2019

Fluids Barriers CNS

Self Cite

View full text Add to dashboard Cite

show abstract

“…In a prospective study, Junkkari et al [ 37 ] showed that 43% of 145 iNPH patients experienced a clinically significant improvement in HRQoL one year after shunt surgery. In the same material, the authors found that participants with a poor starting point (a higher degree of iNPH symptoms) were less likely to experience improved HRQoL despite a favourable clinical outcome [ 38 ]. iNPH patients who had to wait for surgery had a worse clinical outcome compared to those who were operated on early [ 30 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Depressive symptoms, functional impairment, and health-related quality of life in idiopathic normal pressure hydrocephalus: A population-based study

Andersson,

Maripuu,

Sjövill

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

Background Maximising quality of life is a central goal for all healthcare, especially when dealing with dementing disorders. In this study we aimed to compare health-related quality of life (HRQoL), depressive symptoms and functional impairment between individuals with and without idiopathic normal pressure hydrocephalus (iNPH) from the general population. Methods A total of 122 individuals, 30 with iNPH (median age 75 years, 67 females) underwent neurological examinations and computed tomography of the brain with standardised rating of imaging findings and clinical symptoms. The participants completed the Geriatric Depression Scale (GDS-15) and the HRQoL instrument EQ5D-5L. In addition, the modified Rankin Scale (mRS) was used to evaluate functional impairment. Results Compared with participants without iNPH, those with iNPH reported a higher score on GDS-15 (median 3 vs 1) and mRS (median 2 vs 1) (p < 0.05). Further, those with iNPH rated lower on EQ5D-5L (index 0.79, VAS 70) than those without iNPH (index 0.86, VAS 80) (p < 0.05). In logistic regression models, low HRQoL was associated with more depressive symptoms, a higher degree of iNPH symptoms, and lower functional status. Conclusions In this population-based sample, those with iNPH had more depressive symptoms, lower functional status, and worse quality of life compared to those without iNPH. The strongest association with low HRQoL was found for depressive symptoms, functional level, and degree of iNPH symptoms. These results underline the value of shunt surgery because of its potential to reduce symptoms and disability in iNPH and therefore improve HRQoL.

show abstract

“…The effect of co morbid AD to INPH on the short and long term shunt surgery outcome had been studied. There are encouraging studies showing that gait speed, gait quality, psychomotor speed, attention, overall cognitive function, urination improved in patients with INPH after shunt surgery irrespective of the presence of AD pathology [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

The Significance of Cerebral Comorbidities in Idiopathic Normal Pressure Hydrocephalus

Kaya

Işık

2018

BJSTR

View full text Add to dashboard Cite

Idiopathic normal pressure hydrocephalus (INPH) is a potentially treatable geriatric disease which mostly presented with triad of cognitive, gait and sphincter symptoms. There are many papers concerning vascular co morbidities such as diabetes mellitus, hypertension, ischemic heart disease and stroke in INPH. However, few data exist about cerebral comorbidities such as lewy body diseases, frontotemporal dementia, Alzheimer's disease and cerebral microbleeds, and their impacts on the prognosis and patient management. This mini review aims to highlight those cerebral pathologies and their associations with INPH.

show abstract

Why Does the Health-Related Quality of Life in Idiopathic Normal-Pressure Hydrocephalus Fail to Improve Despite the Favorable Clinical Outcome?

Cited by 7 publications

References 34 publications

The Kuopio idiopathic normal pressure hydrocephalus protocol: initial outcome of 175 patients

The Kuopio idiopathic normal pressure hydrocephalus protocol: initial outcome of 175 patients

Depressive symptoms, functional impairment, and health-related quality of life in idiopathic normal pressure hydrocephalus: A population-based study

The Significance of Cerebral Comorbidities in Idiopathic Normal Pressure Hydrocephalus

Contact Info

Product

Resources

About