Abstract
Background:Patients with idiopathic normal-pressure hydrocephalus (iNPH) are typically older adults with multiple comorbidities that are associated with a reduction in the efficacy of iNPH treatment via cerebrospinal fluid (CSF) shunt placement.Objective:The present study aimed to investigate the effectiveness of CSF shunt for iNPH using data from a nationwide epidemiological survey in Japan.Methods:We examined 1,423 patients (581 women) aged ≥60 years (median age [25%–75%]: 77 [73–80] years) who were diagnosed with iNPH following a hospital visit in 2012. Patients who experienced an improvement of at least one modified Rankin Scale (mRS) grade after the CSF shunt were classified as “improvement” while the remaining patients were classified as “non-improvement.” The efficacy of the shunt intervention (n = 842) was analyzed using a binomial logistic regression analysis.Results:An analysis of risk factors associated with shunt placement in patients with mRS grade 2 revealed an association between comorbid chronic ischemic lesions (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11–4.67; p = 0.025) and cervical spondylosis (OR, 3.62; 95% CI, 1.15–11.34; p = 0.027). Patients with mRS grade 3 at study entry had an association with comorbid Alzheimer’s disease (OR, 3.02; 95% CI, 1.44–6.31; p = 0.003).Conclusions:The results presented here showed that any age-related risk is minimal and should not be cause for rejection of surgical treatment options. Clinical decisions regarding CSF shunt should be individualized to each patient, with adequate consideration of the relative risks and benefits, including maximizing a healthy life expectancy.
Highlights
Idiopathic normal-pressure hydrocephalus has been found to be prevalent among older adults and is characterized by gait disturbances, cognitive impairments, and urinary incontinence [1, 2]. idiopathic normal-pressure hydrocephalus (iNPH) is thought to stem from difficulties with the clearance of waste metabolites from the brain [3,4,5]
Clinical decisions regarding cerebrospinal fluid (CSF) shunt should be individualized to each patient, with adequate consideration of the relative risks and benefits, including maximizing a healthy life expectancy
We sought to determine the most important factors to consider when deciding whether a CSF shunt placement procedure is appropriate for a particular patient. iNPH patient symptomatology was assessed using a modified version of the Rankin Scale, which measures the degree of autonomy in activities of daily life [13]
Summary
Idiopathic normal-pressure hydrocephalus (iNPH) has been found to be prevalent among older adults and is characterized by gait disturbances, cognitive impairments, and urinary incontinence [1, 2]. iNPH is thought to stem from difficulties with the clearance of waste metabolites from the brain [3,4,5]. INPH patients are often older adults who experience comorbid disorders These comorbidities can influence the efficacy of shunt treatment for iNPH; the risks that they present have not been clarified in iNPH guidelines. Risk Factors Associated with Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus: A Nationwide Hospital-Based Survey in Japan. Patients with idiopathic normal-pressure hydrocephalus (iNPH) are typically older adults with multiple comorbidities that are associated with a reduction in the efficacy of iNPH treatment via cerebrospinal fluid (CSF) shunt placement. Results: An analysis of risk factors associated with shunt placement in patients with mRS grade 2 at study entry revealed an association between comorbid chronic ischemic lesions (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11–4.67; p = 0.025) and cervical spondylosis (OR, 3.62; 95% CI, 1.15–11.34; p = 0.027).
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