136724 - Incidence diagnostic criteria and outcome.pdf (1.35 MB)
Incidence, diagnostic criteria and outcome following ventriculoperitoneal shunting of idiopathic normal pressure hydrocephalus in a memory clinic population: A prospective observational cross-sectional and cohort study
journal contribution
posted on 2023-05-20, 09:39 authored by Razay, G, Wimmer, M, Iain RobertsonIain RobertsonObjective To evaluate diagnostic criteria for idiopathic normal pressure hydrocephalus (INPH) among patients with memory impairment, and to estimate the incidence of INPH. Design Prospective observational cross-section and cohort study of diagnostic accuracy. Setting Memory Disorders Clinic following referral by the medical practitioners. Participants 408 consecutive patients enrolled 2010– 2014. Outcome measures Reference diagnostic test was the clinical judgement of an experienced specialist based on the presence of cognitive impairment and/or balance and gait disorders in the presence of dilated ventricles. Mini-Mental State Examination (MMSE), Tinetti balance and gait tests were performed before and 12 months after ventriculoperitoneal shunt surgery. The association between reference diagnosis, clinical and brain CT scan measurements was estimated by multivariate Poisson regression. Triage index diagnostic test scores were calculated from the regression coefficients, with diagnostic thresholds selected using receiver operating characteristic analysis. Results The presence of balance and/or gait disorders, especially fear of falling, difficulty standing on toes/ heals, urinary disturbances, ventriculomegaly with Evans ratio greater than Combined Diagnostic Threshold (0.377-{Maximum width of posterior horns*0.0054}), strongly predict the diagnosis of INPH; while hallucinations and/or delusions and forgetfulness reduce the likelihood of the diagnosis. This triage index test had high sensitivity (95.2%) and specificity (91.7%). 62 of 408 (15%) participants with cognitive impairment had INPH, an incidence of 11.9/100 000/year and 120/100 000/year over 75 years. 96% of participants following shunting, compared with 45% of the non-shunted, improved by over 25% of available measurable improvement in either MMSE or balance/gait scores (51% difference; 95%CI 28% to 74%; p<0.001), and 56% vs 5% improved by over 50% of maximum in both (51% difference; 95%CI 30% to 73%; p<0.001).
History
Publication title
BMJ OpenVolume
9Issue
12Article number
e028103Number
e028103Pagination
1-12ISSN
2044-6055Department/School
Tasmanian School of MedicinePublisher
B M J GroupPlace of publication
United KingdomRights statement
© Author(s) (or their employer(s)) 2019. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Repository Status
- Open