Cerebrospinal Fluid Shunting Improves Long-Term Quality of Life in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2019 ◽  
Author(s):  
Hanna Israelsson ◽  
Anders Eklund ◽  
Jan Malm
Keyword(s):  
Quality Of Life ◽  
Cerebrospinal Fluid ◽  
Health Status ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Symptoms Of Depression ◽  
Cerebrospinal Fluid Shunting

Abstract BACKGROUND The short- and long-term impact of cerebrospinal fluid shunting on quality of life (QoL) in idiopathic normal pressure hydrocephalus (INPH) is poorly understood. OBJECTIVE To investigate QoL in shunted INPH patients compared to the population and to investigate which factors influence QoL in INPH. METHODS INPH patients consecutively shunted in Sweden during 2008-2010 were scrutinized. Population-based controls were age- and sex-matched to the patients. Included participants were the following: 176 INPH patients and 368 controls. QoL was assessed using the EuroQol 5-dimension 5-level (EQ5D5L) instrument, which measures overall QoL and health status in 5 dimensions. Independency (accommodation and/or need for in-home care) and comorbidities were assessed. Patients were followed up 6-45 mo after surgery (mean follow-up time: 21 mo). RESULTS Shunting improved QoL (P < .001) and health status in all dimensions (P < .005). Shunted INPH patients had lower QoL than controls (P < .001). The patients’ health status in mobility, self-care, daily activities, and anxiety/depression was worse than the controls both before and after surgery (P < .001). The main predictors of low QoL in INPH were symptoms of depression (P < .001) and severity of gait disturbance (P = .001). Fewer INPH patients than controls lived independently (45% vs 85%, P < .001). Time after shunting had no influence on QoL. CONCLUSION QoL remains improved in shunted INPH patients at a mean follow-up time of 21 mo, but the patients do not reach the same QoL as the population. Symptoms of depression and severity of gait disturbance are the strongest predictors of low QoL in INPH.

Smartphone app as a follow-up tool after cardiac rehabilitation: Single-arm feasibility study (Preprint)

2018 ◽  
Author(s):  
Pernille Lunde ◽  
Birgitta Blakstad Nilsson ◽  
Astrid Bergland ◽  
Asta Bye
Keyword(s):  
Quality Of Life ◽  
Health Status ◽  
Cardiac Rehabilitation ◽  
Potential Effect ◽  
Goal Achievement ◽  
Recruitment Rate ◽  
Floor Effect

BACKGROUND Long-term maintenance of preventive activities is fundamental for achieving improved outcomes of cardiac rehabilitation (CR). Despite this, it is shown to be a major challenge for many patients to follow recommendations and thereby adhere to a heart-friendly lifestyle. Smartphone applications (apps) have been emphasized as potential tools to promote preventive activities after attendance in a CR program. Before commencing a trial to assess the potential effect of using an app for long-term adherence to preventive activities after attendance in CR, a study to assess the feasibility of the intervention is warranted. OBJECTIVE To assess the feasibility of an intervention where an app is used as a tool enabling individualized and monitored follow-up for patients after attendance in a CR program. METHODS Experimental, pre-post single arm trial, lasting for 12 weeks. All patients received access to an app aimed to guide people to change or to maintain a heart friendly lifestyle. During the study period, they got weekly, individualized follow-up through the app, based on their own goalsetting. Feasibility outcome assessed were adherence to the intervention, recruitment rate, resource requirements and efficacy regarding capability to detect a difference on quality of life (QoL), health status and perceived goal achievement as well as evaluating ceiling and floor effect in these outcomes. Criteria’s for success were preset to be able to evaluate whether the intervention were feasible in a potential future RCT. RESULTS All 14 patients included in the study used the app to promote preventive activities throughout the study. Satisfaction with the technology were high and the patients found the technology based follow-up intervention both useful and motivational. In total, 71% of the patients completed CR were eligible for a potential RCT as well as for the present study. Ceiling effect was achieved in more than 50% of the patients in questionnaires evaluating quality of life (SF-36 and COOP/WONCA) and health status (EQ-5D). Overall self-rated health status (EQ VAS) and perceived goal achievement were found to be able to detect a difference through the study. CONCLUSIONS Individual follow-up intervention through an app after attendance in CR is feasible. All patients used the app for preventive activities and found the follow-up intervention through an app as both useful and motivating for adherence to a heart-friendly lifestyle. Several points of guidance from the patients in the current study has been taken along and have contributed to the final design of the RCT now in the field.

LONG-TERM OUTCOME IN PATIENTS WITH SUSPECTED NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽  
2007 ◽  
Vol 60 (2) ◽  
pp. 327-332 ◽  
Author(s):  
Babar Kahlon ◽  
Johan Sjunnesson ◽  
Stig Rehncrona
Keyword(s):  
Cerebrospinal Fluid ◽  
Reaction Time ◽  
Normal Pressure Hydrocephalus ◽  
Barthel Index ◽  
Normal Pressure ◽  
Shunt Surgery ◽  
Term Outcome ◽  
Long Term Outcome

Abstract OBJECTIVE To evaluate the outcome of patients with suspected normal pressure hydrocephalus at 6 months and 5 years after shunt surgery. METHODS Seventy-five patients (mean age, 72.5 6 9 yr), with normal pressure hydrocephalus symptoms were included. Fifty-four patients with positive lumbar infusion and/or cerebrospinal fluid tap tests received a cerebrospinal fluid shunt, whereas 21 patients with negative test results did not undergo operation. Walk, reaction time, memory, and identical forms tests were used as baseline (before surgery) tests and were repeated at short- (6.1 6 4.6 mo) and long-term (5.5 6 1.4 yr) follow-up evaluations. Activities of daily life functions were assessed using the Barthel index. RESULTS At the 6-month follow-up examination, 83% of the operated patients improved in gait, 65% improved in reaction time, 46% improved in memory, and 31% improved in identical forms tests; 96% found themselves subjectively improved. Because of unrelated mortality (37%) and declining general health from comorbidity, only 27 patients were available for the 5-year follow-up evaluation. Twenty-three of these patients had been treated with a shunt and had a remaining improvement in close to 40% in gait and reaction time, whereas fewer than 10% had an improvement in cognitive tests. Fifty-six percent reported subjective improvement compared with preoperative findings. More patients (64%) improved if younger than 75 years; for patients older than 75 years, only 11% of the patients improved. The Barthel index was higher (P &lt; 0.05) in improved patients. CONCLUSION Patients with normal pressure hydrocephalus benefit from shunt surgery for at least 5 years. High mortality rate, comorbidity, and old age hamper good long-term outcome and emphasize the importance of patient selection.

PS01.122: LONG-TERM QUALITY OF LIFE IN PATIENTS AFTER MCKEOWN VERSUS IVOR LEWIS ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 84-84
Author(s):  
Egle Jezerskyte ◽  
Suzanne Gisbertz ◽  
Mark I Van Berge Henegouwen ◽  
Luca Saadeh ◽  
Marco Scarpa
Keyword(s):  
Quality Of Life ◽  
Health Status ◽  
Global Health ◽  
Cognitive Functioning ◽  
Ivor Lewis ◽  
Physical Role ◽  
Eortc Qlq

Abstract Background Treatment of distal esophageal and gastroesophageal junction (GEJ) cancers is challenging. The therapy for these cancers mainly consist of (neo)adjuvant chemo(radio)therapy and surgery. There are different surgical approaches possible for these patients: transthoracic esophagectomy with a cervical anastomosis (McKeown) or an intrathoracic anastomosis (Ivor Lewis). However, there is no evidence which is the preferred approach in terms of oncology, morbidity and quality of life. The aim of this study was to investigate the difference in the long-term quality of life in patients undergoing McKeown (McK) versus Ivor Lewis (IL) esophagectomy in a tertiary referral center. Methods Consecutive patients after either McK or IL for distal oesophagus, GEJ or proximal gastric carcinoma were asked to fill in EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires to evaluate quality of life during the period of January 2014 – December 2017. EORTC QLQ-INFO25 quality of life questionnaire was used to evaluate information needs of patients in both groups. All answers with a long follow up (> 1 year) after surgery were analysed. Results In the McK group 62 and in the IL group 110 patients were included. Median follow up was 3 years for McK and 2 years for IL. Median age was 62,4 years. Cognitive functioning was significantly better in the IL group (P = 0.038). Complaints of dyspnoe (P = 0.004) and dysphagia (P = 0.028) were significantly higher in the McK group. Patients after IL had significantly less trouble with eating with others (P = 0.003), trouble with taste (P = 0.032), chocking when swallowing (P = 0.022) and trouble with talking (P = 0.038). There was no significant difference in global health status or physical, role, social or emotional functioning. Furthermore there was no difference in symptoms of nausea, fatigue, pain, discomfort or information scores between McK and IL groups. Conclusion After a follow up of > 1 year no differences in global health status or physical, role, social or emotional functioning scales between McK and IL esophagectomy were found. However, significant differences in some symptom scales and cognitive functioning were observed in favor of IL. These findings should be taken into consideration when deciding between a McK and IL esophagectomy in patients where both procedures are feasible. Disclosure All authors have declared no conflicts of interest.

Quality of life, need for retreatment, and the re-equilibration phenomenon after venous sinus stenting for idiopathic intracranial hypertension

2020 ◽  
Vol 13 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Rebecca M Garner ◽  
Jennifer Bernhardt Aldridge ◽  
Stacey Q Wolfe ◽  
Kyle M Fargen
Keyword(s):  
Quality Of Life ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Surgical Intervention ◽  
Venous Sinus ◽  
Sinus Stenosis ◽  
Cerebrospinal Fluid Shunting

BackgroundLong term failure rates after venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) are poorly understood.MethodsRetrospective analysis was performed on a prospectively-maintained single center database to identify patients with medically refractory IIH who underwent VSS. Patients with persistent or severe recurrent symptoms after VSS undergo lumbar puncture (LP), therefore LP serves as a marker for treatment failure.Results81 patients underwent VSS with a mean follow-up of 10 months; 44 (54.3%) patients underwent LP after VSS due to persistent or recurrent symptoms at a mean of 12 months (median 7, range 2–43). There was a mean decrease in opening pressure (OP) on LP from pre- to post-VSS of 9.1 cm H2O (median 9.5). Overall, a total of 21 (25.9%) patients underwent further surgical intervention following VSS, including five who underwent repeat VSS (6.2% of total) and 18 who underwent cerebrospinal fluid shunting (22.2% of total). There was a non-significant (p=0.18) but overall increase in quality of life scores from pre-stenting (61.2) to last follow-up (71.2), and a significant decrease in Headache Impact Test-6 (HIT-6) scores (p=0.03) with mean pre-stenting and last follow-up scores of 62.7 and 55.8, respectively.ConclusionsVSS is an effective treatment for venous sinus stenosis in IIH; however, this study found higher rates of symptomatic recurrence and need for further surgical intervention (26%) than previously reported in the literature. Recurrence of symptoms occurred at a median of 7 months, even though OP remained lower at follow-up LP, suggestive of a re-equilibration phenomenon.

scholarly journals Risk factors, comorbidities, quality of life, and complications after surgery in idiopathic normal pressure hydrocephalus: review of the INPH-CRasH study

2020 ◽  
Vol 49 (4) ◽  
pp. E8
Author(s):  
Hanna Israelsson ◽  
Jenny Larsson ◽  
Anders Eklund ◽  
Jan Malm
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Abdominal Pain ◽  
Adverse Events ◽  
Psychosocial Factors ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus

OBJECTIVEIdiopathic normal pressure hydrocephalus (INPH) is a dementia treatable by insertion of a shunt that drains CSF. The cause of the disease is unknown, but a vascular pathway has been suggested. The INPH-CRasH (Comorbidities and Risk Factors Associated with Hydrocephalus) study was a modern epidemiological case-control study designed to prospectively assess parameters regarding comorbidities and vascular risk factors (VRFs) for INPH, quality of life (QOL), and adverse events in patients with shunted INPH. The objective of this review was to summarize the findings of the INPH-CRasH study.METHODSVRFs, comorbidities, QOL, and adverse events were analyzed in consecutive patients with INPH who underwent shunt placement between 2008 and 2010 in 5 of 6 neurosurgical centers in Sweden. Patients (n = 176, within the age span of 60–85 years and not having dementia) were compared to population-based age- and gender-matched controls (n = 368, same inclusion criteria as for the patients with INPH). Assessed parameters were as follows: hypertension; diabetes; obesity; hyperlipidemia; psychosocial factors (stress and depression); smoking status; alcohol intake; physical activity; dietary pattern; cerebrovascular, cardiovascular, or peripheral vascular disease; epilepsy; abdominal pain; headache; and clinical parameters before and after surgery. Parameters were assessed through questionnaires, clinical examinations, measurements, ECG studies, and blood samples.RESULTSFour VRFs were independently associated with INPH: hyperlipidemia, diabetes, obesity, and psychosocial factors. Physical inactivity and hypertension were also associated with INPH, although not independently from the other risk factors. The population attributable risk percent for a model containing all of the VRFs associated with INPH was 24%. Depression was overrepresented in patients with INPH treated with shunts compared to the controls (46% vs 13%, p < 0.001) and the main predictor for low QOL was a coexisting depression (p < 0.001). Shunting improved QOL on a long-term basis. Epilepsy, headache, and abdominal pain remained common for a mean follow-up time of 21 months in INPH patients who received shunts.CONCLUSIONSThe results of the INPH-CRasH study are consistent with a vascular pathophysiological component of INPH. In clinical care and research, a complete risk factor analysis as well as screening for depression and a measurement for QOL should probably be included in the workup of patients with INPH. The effect of targeted interventions against modifiable VRFs and antidepressant treatment in INPH patients should be evaluated. Seizures, headache, and abdominal pain should be inquired about at postoperative follow-up examinations.

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

2021 ◽  
Author(s):  
A. Junkkari ◽  
H. Sintonen ◽  
N. Danner ◽  
H. K. Jyrkkänen ◽  
T. Rauramaa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Normal Pressure ◽  
Health Related Quality ◽  
Hrqol Outcome ◽  
Related Quality ◽  
Long Term Follow Up ◽  
Health Related

Abstract Background Health-related quality of life (HRQoL) is severely impaired in persons with idiopathic normal pressure hydrocephalus (iNPH). The HRQoL improves in a number of patients after the placement of a cerebrospinal fluid (CSF) shunt, but long-term follow-up of HRQoL is rare. Methods Extended follow-up (60 months) of a prospective cohort study involving 189 patients with iNPH who underwent shunt surgery. Preoperative variables were used to predict favorable HRQoL outcome (improvement or non-deterioration) measured by the 15D instrument 5 years after shunting. Results Out of the 189 initially enrolled study participants, 88 had completed 5-year HRQoL follow-up (46%), 64 had died (34%), and 37 (20%) failed to complete the HRQoL follow-up but were alive at the end of the study. After initial post-operative HRQoL improvement, HRQoL deteriorated so that 37/88 participants (42%) had a favorable HRQoL outcome 5 years after shunting. Multivariate binary logistic regression analysis indicated that younger age (adjusted OR 0.86, 95% CI 0.77–0.95; p < 0.005), lower body mass index (adjusted OR 0.87, 95% CI 0.77–0.98; p < 0.05) and better Mini-Mental State Examination performance (adjusted OR 1.16, 95% CI 1.01–1.32; p < 0.05) before surgery predicted favorable 5-year outcome. Conclusions This extended follow-up showed that the self-evaluated HRQoL outcome is associated with iNPH patients’ pre-operative cognitive status, overweight and age. The post-operative deterioration may reflect the natural progression of iNPH, but also derive from aging and comorbidities. It indicates a need for long-term follow-up.

Long term follow-up in quality of life after mitral valve surgery

2012 ◽  
Vol 60 (S 01) ◽  
Author(s):  
I Kammerer ◽  
M Höhn ◽  
AH Kiessling ◽  
S Becker ◽  
FU Sack
Keyword(s):  
Quality Of Life ◽  
Mitral Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Long Term Follow Up
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