Abstract
Idiopathic normal pressure hydrocephalus (INPH) is a syndrome of ventriculomegaly, gait impairment, cognitive decline and incontinence that occurs in an elderly population prone to many types of comorbidities. Identification of the comorbidities is thus an important part of the clinical management of INPH patients. In 2011, a task force was appointed by the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders (ISHCSF) with the objective to compile an evidence-based expert analysis of what we know and what we need to know regarding comorbidities in INPH. This article is the final report of the task force. The expert panel conducted a comprehensive review of the literature. After weighing the evidence, the various proposals were discussed and the final document was approved by all the task force members and represents a consensus of expert opinions. Recommendations regarding the following topics are given: I. Musculoskeletal conditions; II. Urinary problems; III. Vascular disease including risk factors, Binswanger disease, and white matter hyperintensities; IV. Mild cognitive impairment and Alzheimer disease including biopsies; V. Other dementias (frontotemporal dementia, Lewy body, Parkinson); VI. Psychiatric and behavioral disorders; VII. Brain imaging; VIII. How to investigate and quantify. The task force concluded that comorbidity can be an important predictor of prognosis and post-operative outcome in INPH. Reported differences in outcomes among various INPH cohorts may be partly explained by variation in the rate and types of comorbidities at different hydrocephalus centers. Identification of comorbidities should thus be a central part of the clinical management of INPH where a detailed history, physical examination, and targeted investigations are the basis for diagnosis and grading. Future INPH research should focus on the contribution of comorbidity to overall morbidity, mortality and long-term outcomes.
Highlights
The International Society for Hydrocephalus and Cerebrospinal Fluid Disorders (ISHCSF) has identified six fields of interest for investigation by individual task forces
Comorbidity is an important factor in the prognosis and post-operative outcome of shunt surgery for Idiopathic Normal Pressure Hydrocephalus (INPH)
Differences between INPH cohorts sampled at different hydrocephalus centers may be partly explained by variations in comorbidity across those centers
Summary
Background and objective The International Society for Hydrocephalus and Cerebrospinal Fluid Disorders (ISHCSF) has identified six fields of interest for investigation by individual task forces. It has been reported that patients fulfilling the criteria for BD with enlarged ventricles, extensive vascular white matter changes and symptoms compatible with INPH who had negative responses to infusion and drain prognostic tests, showed improved motor and psychometric functions after shunt surgery [44]. It has been observed that in patients with INPH, the subarachnoid space in the Sylvian fissures is dilated (or at least not narrowed) while at the same time those over the high cerebral convexity and medial surface are narrowed [101] This disproportionately enlarged subarachnoid space hydrocephalus (DESH) [101] has been reported to differentiate INPH from brain atrophy in Alzheimer’s disease, results that need to be confirmed.
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