From the Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry (D.J., T.M., I.S.), Hydrocephalus research unit, Department of Clinical Neuroscience and Rehabilitation (K.R., C.W.), Institute of Neuroscience and Physiology, Department of Radiology, Institute of Clinical Sciences (C.J.), Sahlgrenska Academy, University of Gothenburg, Sweden University of Gothenburg, Sweden.
Neurology. 2014 Apr 22;82(16):1449-54. doi: 10.1212/WNL.0000000000000342. Epub 2014 Mar 28.
The aim of this study was to determine the prevalence of idiopathic normal-pressure hydrocephalus (iNPH) in elderly persons in a large population-based sample using radiologic and clinical examinations.
We examined representative elderly populations aged 70 years and older that had undergone neuropsychiatric evaluations and CT of the brain between 1986 and 2000 (n = 1,238). Gait was evaluated by clinical examination and history of walking difficulty. Cognitive function was evaluated with the Mini-Mental State Examination and urinary incontinence by self-report. iNPH was diagnosed in concordance with the American-European iNPH guidelines. Exclusion criteria were history of meningitis, severe head trauma, and subarachnoid hemorrhage.
The prevalence of probable iNPH was 0.2% in those aged 70-79 years (n = 2) and 5.9% (n = 24) in those aged 80 years and older, with no difference between men and women. Only 2 of these persons had been treated for iNPH. Hydrocephalic ventricular enlargement, i.e., a CT image consistent with NPH, was found in 56 persons (4.5%). An Evans Index >0.3 was found in 256 (20.7%) and occluded sulci at the high convexity in 67 persons (5.4%). All of these findings were more common in the older age groups.
Many elderly possess clinical and imaging features of iNPH, especially those older than 80 years. The number of persons with iNPH is probably much higher than the number of persons currently treated.
本研究旨在通过影像学和临床检查，确定大样本基础人群中老年特发性正常压力脑积水（iNPH）的患病率。
我们对 1986 年至 2000 年间接受神经精神评估和脑部 CT 的 70 岁及以上的代表性老年人群进行了检查（n=1238）。通过临床检查和行走困难史评估步态。采用简易精神状态检查评估认知功能，通过自我报告评估尿失禁。根据美国-欧洲 iNPH 指南诊断 iNPH。排除标准为脑膜炎、严重头部外伤和蛛网膜下腔出血病史。
70-79 岁年龄组中可能患有 iNPH 的患者比例为 0.2%（n=2），80 岁及以上年龄组中为 5.9%（n=24），男女之间无差异。仅有 2 名患者接受了 iNPH 治疗。56 名患者（4.5%）存在脑积水脑室扩大，即符合 NPH 的 CT 图像。256 名患者（20.7%）存在 Evans 指数>0.3，67 名患者（5.4%）存在高凸面闭塞脑沟。所有这些发现均更常见于年龄较大的组。
许多老年人存在 iNPH 的临床和影像学特征，尤其是 80 岁以上的老年人。患有 iNPH 的人数可能远高于目前接受治疗的人数。
