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Long-term effects of complications and vascular comorbidity in idiopathic normal pressure hydrocephalus: a quality registry study.

Abstract

BACKGROUND

There is little knowledge about the factors influencing the long-term outcome after surgery for idiopathic normal pressure hydrocephalus (iNPH).

OBJECTIVE

To evaluate the effects of reoperation due to complications and of vascular comorbidity (hypertension, diabetes, stroke and heart disease) on the outcome in iNPH patients, 2-6 years after shunt surgery.

METHODS

We included 979 patients from the Swedish Hydrocephalus Quality Registry (SHQR), operated on for iNPH during 2004-2011. The patients were followed yearly by mailed questionnaires, including a self-assessed modified Rankin Scale (smRS) and a subjective comparison between their present and their preoperative health condition. The replies were grouped according to the length of follow-up after surgery. Data on clinical evaluations, vascular comorbidity, and reoperations were extracted from the SHQR.

RESULTS

On the smRS, 40% (38-41) of the patients were improved 2-6 years after surgery and around 60% reported their general health condition to be better than preoperatively. Reoperation did not influence the outcome after 2-6 years. The presence of vascular comorbidity had no negative impact on the outcome after 2-6 years, assessed as improvement on the smRS or subjective improvement of the health condition, except after 6 years when patients with hypertension and a history of stroke showed a less favorable development on the smRS.

CONCLUSION

This registry-based study shows no negative impact of complications and only minor effects of vascular comorbidity on the long-term outcome in iNPH.

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  • Authors+Show Affiliations

    ,

    Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden. kerstin.andren@neuro.gu.se.

    ,

    Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden.

    ,

    Department of Radiation Sciences, Biomedical Engineering, R&D, Umeå University, 901 85, Umeå, Sweden.

    ,

    Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden.

    ,

    Department of Pharmacology and Clinical Neuroscience, Umeå University, 901 87, Umeå, Sweden.

    ,

    Department of Pharmacology and Clinical Neuroscience, Umeå University, 901 87, Umeå, Sweden.

    ,

    Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden.

    Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden.

    Source

    Journal of neurology 265:1 2018 Jan pg 178-186

    MeSH

    Aged
    Comorbidity
    Female
    Humans
    Hydrocephalus, Normal Pressure
    Longitudinal Studies
    Male
    Registries
    Retrospective Studies
    Statistics, Nonparametric
    Treatment Outcome
    Vascular Diseases
    Ventriculoperitoneal Shunt

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    29188384

    Citation

    TY - JOUR T1 - Long-term effects of complications and vascular comorbidity in idiopathic normal pressure hydrocephalus: a quality registry study. AU - Andrén,Kerstin, AU - Wikkelsö,Carsten, AU - Sundström,Nina, AU - Agerskov,Simon, AU - Israelsson,Hanna, AU - Laurell,Katarina, AU - Hellström,Per, AU - Tullberg,Mats, Y1 - 2017/11/29/ PY - 2017/08/24/received PY - 2017/11/13/accepted PY - 2017/12/1/pubmed PY - 2018/7/28/medline PY - 2017/12/1/entrez KW - Complications KW - Concomitant disease KW - Dementia KW - Gait KW - Hydrocephalus KW - Normal pressure KW - Registries KW - Risk factors SP - 178 EP - 186 JF - Journal of neurology JO - J. Neurol. VL - 265 IS - 1 N2 - BACKGROUND: There is little knowledge about the factors influencing the long-term outcome after surgery for idiopathic normal pressure hydrocephalus (iNPH). OBJECTIVE: To evaluate the effects of reoperation due to complications and of vascular comorbidity (hypertension, diabetes, stroke and heart disease) on the outcome in iNPH patients, 2-6 years after shunt surgery. METHODS: We included 979 patients from the Swedish Hydrocephalus Quality Registry (SHQR), operated on for iNPH during 2004-2011. The patients were followed yearly by mailed questionnaires, including a self-assessed modified Rankin Scale (smRS) and a subjective comparison between their present and their preoperative health condition. The replies were grouped according to the length of follow-up after surgery. Data on clinical evaluations, vascular comorbidity, and reoperations were extracted from the SHQR. RESULTS: On the smRS, 40% (38-41) of the patients were improved 2-6 years after surgery and around 60% reported their general health condition to be better than preoperatively. Reoperation did not influence the outcome after 2-6 years. The presence of vascular comorbidity had no negative impact on the outcome after 2-6 years, assessed as improvement on the smRS or subjective improvement of the health condition, except after 6 years when patients with hypertension and a history of stroke showed a less favorable development on the smRS. CONCLUSION: This registry-based study shows no negative impact of complications and only minor effects of vascular comorbidity on the long-term outcome in iNPH. SN - 1432-1459 UR - https://www.unboundmedicine.com/medline/citation/29188384/Long-term_effects_of_complications_and_vascular_comorbidity_in_idiopathic_normal_pressure_hydrocephalus:_a_quality_registry_study. L2 - https://dx.doi.org/10.1007/s00415-017-8680-z ER -