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. 2018 Jan;265(1):178-186.
doi: 10.1007/s00415-017-8680-z. Epub 2017 Nov 29.

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

Kerstin Andrén  1 , Carsten Wikkelsö  2 , Nina Sundström  3 , Simon Agerskov  2 , Hanna Israelsson  4 , Katarina Laurell  4 , Per Hellström  2 , Mats Tullberg  2
Affiliations

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

Kerstin Andrén et al. J Neurol. 2018 Jan.

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.

Keywords: Complications; Concomitant disease; Dementia; Gait; Hydrocephalus; Normal pressure; Registries; Risk factors.

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Conflict of interest statement

Conflicts of interest

KA, NS, SA, HI, KL, PH, and MT report no disclosures. CW receives honorarium from Johnson & Johnson for lecturing.

Funding

This study was supported by grants from the Edit Jacobson Foundation, the Gothenburg Medical Society, the Swedish State Support for Clinical Research (LUA-ALF) and the Gothenburg Foundation for Neurological Research (ISNF).

Figures

Fig. 1
Fig. 1
Shift analysis of modified Rankin Scale (mRS) scores (0–5) in 979 iNPH patients: at baseline and 3 months after surgery, and self-reported mRS (smRS) at 2–6 years after surgery. Black numbers within the bars represent the number of patients obtaining each score on the mRS and smRS. White numbers show the proportion of patients with scores between 0 and 2, i.e., able to live a life independent of help from others
Fig. 2
Fig. 2
Postoperative health condition in 979 iNPH patients. Percentage of iNPH patients reporting better, unchanged or worse health condition, of whom the following question was asked: “How are you feeling now, compared with your condition before surgery?” after 2–6 years. The 3-month evaluation was carried out in the clinical follow-up setting; results at the 2- to 6-year evaluation come from follow-up questionnaires. The number of available answers at each time point is indicated above the bars
Fig. 3
Fig. 3
Complications causing first-time reoperations in 979 iNPH patients, visualized year by year after primary surgery. For each year, the percentage of patients who needed reoperation because of complications is represented in the bar chart, in four groups based on the type of complication. The corresponding numbers of patients and the total number of available patients for each year are shown in the table
See this image and copyright information in PMC

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