Normal pressure hydrocephalus: a qualitative study on outcome

Thirteen patients underwent shunt surgery. Favorable outcome in gait function occurred in 5 of 35 patients and was related to younger age, absence of cardiovascular risk factors (CVRF) and white matter lesions (WML), and shunt surgery. Cognitive outcome was favorable in 9 of 35 patients and associated with shunt surgery (trend level). Of the patients subjected to surgery, favorable outcome in motor function was related to younger age at T0 and absence of CVRF and WML (trend level).

Conclusion

Shunt surgery had a significant effect on gait and less on cognition. Favorable outcome in gait was also associated with younger age and absence of CVRF and WML.

normal pressure hydrocephalus; natural history; shunt surgery

35 patients	Favorable (n=5)	Unfavorable (n=30)	p-value
Age at T0 (<70 years)	5	2	<0.00001 ^*****
Age of onset (<70 years)	5	7	0.002 ^***
T0 to T1 (<3 years)	4	15	0.347
Duration (<3 years)	5	19	0.157
First symptom (gait Vs cognition)	3	19	1.000
Complete triad at T0	1	13	0.627
MMSE (normal Vs abnormal) (n=31, 4 Vs 27) ^a	3	11	0.304
CVRF (at least one Vs none)	1	25	0.010 ^*
WML (at least one Vs none)	0	20	0.009 ^**
Surgery	5	8	0.004 ^***
Response to LP (n=31, 5 Vs 26) ^a	4	22	1.000
CSF stroke volume (>42 μg) (n=20, 3 Vs 17) ^a	2	15	0.404

35 patients	Favorable (n=9)	Unfavorable (n=26)	p-value
Age (<70)	4	8	0.361
Age of onset (<70)	3	4	0.340
T0 to T1 (3< Vs >2 y)	5	14	0.619
Duration (<5 Vs >4 y)	3	17	0.129
First symptom (gait Vs cognition)	8	14	0.109
Complete triad at T0	1	12	0.262
MMSE (normal Vs abnormal) (n=31, 4 Vs 27) ^a	2	12	0.240
CVRF (at least one)	6	20	0.665
WML (at least one)	3	17	0.129
Surgery	6	7	0.050
Response to LP (n=31, 7 Vs 24) ^a	6	20	1.000
CSF stroke volume (>42 μg) (n=20, 5 Vs 15) ^a	5	12	0.539

13 patients	Gait: favorable (n=5)	Gait: unfavorable (n=8)	p-value	Cognition: favorable (n=6)	Cognition: unfavorable (n=7)	p-value
Age (<70)	5	1	0.005 ^**	3	3	1.000
Age of onset (<70)	5	3	0.075	3	5	0.592
T0 to T1 (<3 years)	5	3	0.075	5	3	0.256
Duration (<5 years)	5	4	0.086	6	3	0.266
First symptom (gait)	3	7	0.580	6	4	0.559
Complete triad at T0	1	4	0.565	2	3	1.000
MMSE (below cut-off) (n=12)	3	2	0.222	2	3	1.000
CVRF (at least one Vs none)	1	7	0.032 ^*	3	5	0.592
WML (at least one Vs none)	0	5	0.075	1	4	0.266
Response to LP (n=12)	4	7	0.417	4	7	0.417
CSF stroke volume (n=8) ^a	2	5	0.375	4	3	1.000

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[1] Correspondence: Paulo Bugalho; Neurology Department; Hospital de Egas Moniz (CHLO); Rua da Junqueira 126; 1349-019 Lisboa - Portugal; E-mail: paulobugalho@sapo.pt