Natural History, Treatment Outcomes and Quality of Life in Idiopathic Normal Pressure Hydrocephalus (iNPH)

Object To investigate the impact of shunt surgery on the activity, participation, autonomy, and health-related quality of life (HRQOL) of patients with idiopathic normal-pressure hydrocephalus (iNPH) as well as the effect on caregiver burden. Methods Thirty-seven patients (median age 70 years, range 50–89 years) with iNPH were evaluated before and 6 months after surgery. Symptoms and signs were assessed by the iNPH scale, activities of daily living (ADL) with the Functional Independence Measure (FIM) and Assessment of Motor and Process Skills (AMPS), autonomy and participation with Impact on Participation and Autonomy (IPA), and caregiver burden with the Caregiver Burden Scale (CBS). HRQOL was evaluated with the EQ-5D (EuroQol Group–5 Dimension health survey). Results Twenty-four patients (65%) improved clinically (iNPH scale score) and 31 (86%) improved their HRQOL after surgery, almost to the same level as found in the normal population. The patients became more independent in physical and cognitive activities, and participation and autonomy improved. The caregiver burden was decreased among caregivers to male patients but remained unchanged on the overall group level. Conclusions After shunt surgery, patients with iNPH showed improvement in most aspects of social life, they became more independent, and their quality of life returned to nearly normal.

Download Full-text

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

Neurosurgical FOCUS ◽

10.3171/2020.7.focus20466 ◽

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.

Download Full-text

Disability risk or unimproved symptoms following shunt surgery in patients with idiopathic normal-pressure hydrocephalus: post hoc analysis of SINPHONI-2

Journal of Neurosurgery ◽

10.3171/2016.5.jns16377 ◽

2016 ◽

Vol 126 (6) ◽

pp. 2002-2009 ◽

Cited By ~ 9

Author(s):

Shigeki Yamada ◽

Teruo Kimura ◽

Naoto Jingami ◽

Masamichi Atsuchi ◽

Osamu Hirai ◽

...

Keyword(s):

Quality Of Life ◽

Normal Pressure Hydrocephalus ◽

Symptom Severity ◽

Disease Duration ◽

Normal Pressure ◽

Gait Disturbance ◽

Shunt Surgery ◽

Tap Test ◽

Relative Risks

OBJECTIVEThe study aim was to assess the influence of presurgical clinical symptom severity and disease duration on outcomes of shunt surgery in patients with idiopathic normal-pressure hydrocephalus (iNPH). The authors also evaluated the cerebrospinal fluid tap test as a predictor of improvements following shunt surgery.METHODSEighty-three patients (45 men and 38 women, mean age 76.4 years) underwent lumboperitoneal shunt surgery, and outcomes were evaluated until 12 months following surgery. Risks for poor quality of life (Score 3 or 4 on the modified Rankin Scale [mRS]) and severe gait disturbance were evaluated at 3 and 12 months following shunt surgery, and the tap test was also conducted. Age-adjusted and multivariate relative risks were calculated using Cox proportional-hazards regression.RESULTSOf 83 patients with iNPH, 45 (54%) improved by 1 point on the mRS and 6 patients (7%) improved by ≥ 2 points at 3 months following surgery. At 12 months after surgery, 39 patients (47%) improved by 1 point on the mRS and 13 patients (16%) improved by ≥ 2 points. On the gait domain of the iNPH grading scale (iNPHGS), 36 patients (43%) improved by 1 point and 13 patients (16%) improved by ≥ 2 points at 3 months following surgery. Additionally, 32 patients (38%) improved by 1 point and 14 patients (17%) by ≥ 2 points at 12 months following surgery. In contrast, 3 patients (4%) and 2 patients (2%) had worse symptoms according to the mRS or the gait domain of the iNPHGS, respectively, at 3 months following surgery, and 5 patients (6%) and 3 patients (4%) had worse mRS scores and gait domain scores, respectively, at 12 months after surgery. Patients with severe preoperative mRS scores had a 4.7 times higher multivariate relative risk (RR) for severe mRS scores at 12 months following surgery. Moreover, patients with severe gait disturbance prior to shunt surgery had a 46.5 times greater multivariate RR for severe gait disturbance at the 12-month follow-up. Patients without improved gait following the tap test had multivariate RRs for unimproved gait disturbance of 7.54 and 11.2 at 3 and 12 months following surgery, respectively. Disease duration from onset to shunt surgery was not significantly associated with postoperative symptom severity or unimproved symptoms.CONCLUSIONSPatients with iNPH should receive treatment before their symptoms become severe in order to achieve an improved quality of life. However, the progression of symptoms varies between patients so specific timeframes are not meaningful. The authors also found that tap test scores accurately predicted shunt efficacy. Therefore, indications for shunt surgery should be carefully assessed in each patient with iNPH, considering the relative risks and benefits for that person, including healthy life expectancy.

Download Full-text

Clinical Diagnosis and Treatment Management of Normal Pressure Hydrocephalus

10.5772/intechopen.99222 ◽

2021 ◽

Author(s):

Hüseyin Yakar

Keyword(s):

Quality Of Life ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Clinical Findings ◽

Treatment Modalities ◽

Arachnoid Granulation ◽

Elderly Individuals ◽

Clinical Triad ◽

Unusual Appearance

Inadequate absorption of cerebrospinal fluid (CSF) at the arachnoid granulation level during circulation results in an increase in CSF in the ventricle and certain neuropsychiatric clinical findings. This syndrome, which often presents with ventricular dilatation, progressive cognitive decline, walking difficulties, and urinary incontinence symptoms in elderly individuals, is called Normal Pressure Hydrocephalus (NPH). It is projected that as people’s quality of life improves and their life expectancy rises, more old people would develop this condition. Although a clear clinical triad has been defined, the identification of patients with NPH and the application of effective treatment modalities still pose a number of challenges for neurosurgeons today. However, despite all these difficulties, if diagnosed and treated early, the unusual appearance of these symptoms affecting elderly individuals can be prevented and significant improvements in quality of life can be achieved.

Download Full-text

Surgical treatment of idiopathic normal pressure hydrocephalus (literature rewiew)

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2019-178-2-73-78 ◽

2019 ◽

Vol 178 (2) ◽

pp. 73-78

Author(s):

G. V. Gavrilov ◽

A. V. Stanishevskiy ◽

B. V. Gaydar ◽

D. V. Svistov

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Normal Pressure Hydrocephalus ◽

Surgical Intervention ◽

Pathological Condition ◽

Cognitive Disorders ◽

Normal Pressure ◽

Ventriculoperitoneal Shunting ◽

Pump Valve

Normal pressure hydrocephalus is a pathological condition characterized by ventricular expansion in combination with normal intracranial pressure and manifested by a specific triad of symptoms, including gait disorders, cognitive disorders and urinary incontinence. The prevalence of the disease has not been fully studied and according to various population epidemiological researches reaches 0.3–3 % among patients older than 61 years. A feature that differs normal pressure hydrocephalus from other neurodegenerative diseases is the possibility of full or partial regression of neurological symptoms after surgical treatment. The most common surgical intervention for normal pressure hydrocephalus is ventriculoperitoneal shunting. It is an implantation of a system of catheters connected by pump-valve into the patient’s body, that drainage cerebrospinal fluid from ventricles to abdomen cavity. Correct and timely surgical treatment of normal pressure hydrocephalus allows increasing the quality of life of patients with normal pressure hydrocephalus and, as a result, the quality of life of their relatives and friends.

Download Full-text