Journal
JOURNAL OF THE NEUROLOGICAL SCIENCES
Volume 391, Issue -, Pages 54-60Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jns.2018.05.022
Keywords
Idiopathic normal pressure hydrocephalus; iNPH; Clinical neurology; Outcome; Gait disturbance
Categories
Funding
- Edit Jacobson Foundation
- Rune and Ulla Amlovs Foundation
- Gothenburg Foundation for Neurological Research (ISNF)
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Introduction: Idiopathic Normal Pressure Hydrocephlaus (iNPH) is, despite a vastly improved knowledge of the disorder since its first description still underdiagnosed and undertreated. Because of this, there is a need for further large studies describing the typical symptomatology and reversibility of symptoms in iNPH, which was the aim of this study. Methods: In all, 429 patients (mean age 71 years) were included. Detailed pre- and postoperative examinations of symptoms and signs were analyzed. A composite outcome measure was constructed. Results: Sixty-eight % improved after surgery. Preoperatively, 72% exhibited symptoms from three or four of the assessed domains (gait, balance, neuropsychology and continence) while 41% had symptoms from all four domains. Ninety % had gait disturbances, of which 75% had broad-based gait, 65% shuffling gait and 30% freezing of gait. These disturbances coexisted in most patients preoperatively, but were more likely to appear as isolated findings after surgery. Impaired balance was seen in 53% and retropulsion in 46%. MMSE < 25 was seen in 53% and impaired continence in 86%. Improvements were seen in all symptom domains postoperatively. Conclusions: The iNPH phenotype is characterized by a disturbance in at least 3/4 symptom domains in most patients, with improvements in all domains after shunt surgery. Most patients present with a broad-based and shuffling gait as well as paratonia. Present symptoms in all domains and a shuffling gait at the time of diagnosis seem to predict a favorable postoperative outcome, whereas symptom severity does not.
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