Israelsson Hanna, Allard Per, Eklund Anders, Malm Jan
*Department of Clinical Neuroscience, ‡Department of Clinical Sciences, Division of Psychiatry, §Department of Radiation Sciences, Umeå University, Umeå, Sweden.
Neurosurgery. 2016 Feb;78(2):161-8. doi: 10.1227/NEU.0000000000001093.
If patients with idiopathic normal pressure hydrocephalus (INPH) also have depression, this could have important clinical ramifications in assessment and management of their cognitive function and response to shunting. In many dementias, depression is overrepresented, but the prevalence of depression in shunted patients with INPH is unknown.
The objective of this case-control study was to assess the prevalence of symptoms of depression in shunted INPH patients compared with population-based controls.
INPH patients consecutively shunted from 2008 to 2010 in Sweden were analyzed. Patients remaining after inclusion (within 60-85 years and not having dementia, ie, mini-mental state examination ≥23) had a standardized visit to their healthcare provider and answered an extensive questionnaire. Age- and sex-matched population-based controls underwent the same procedure. Symptoms of depression were assessed using the Geriatric Depression Scale 15 (suspected depression defined as ≥5 points, suspected severe depression as ≥12 points). This study is part of the INPH-CRasH study.
One hundred seventy-six INPH patients and 368 controls participated. After adjustment for age, sex, cerebrovascular disease, and systolic and diastolic blood pressure, patients had a higher mean depression score (patients: 4.9 ± 3.7 SD, controls: 1.9 ± 2.3 SD; OR 1.4, 95% CI 1.3-1.6, P < .001), more patients had suspected depression (46% vs 13%, OR 6.4, 95% CI 3.8-10.9, P < .001), and more patients had suspected severe depression (7.3% vs 0.6%, OR 14.4, 95% CI 3.0-68.6, P < .005).
Symptoms of depression are overrepresented in INPH patients compared with the population, despite treatment with a shunt. Screening for depression should be done in the evaluation of INPH patients in order to find and treat a coexisting depression.
如果特发性正常压力脑积水（INPH）患者同时患有抑郁症，这可能会对其认知功能的评估和管理以及分流治疗反应产生重要的临床影响。在许多痴呆症中，抑郁症的发病率过高，但接受分流治疗的INPH患者中抑郁症的患病率尚不清楚。
本病例对照研究的目的是评估与基于人群的对照组相比，接受分流治疗的INPH患者中抑郁症状的患病率。
对2008年至2010年在瑞典连续接受分流治疗的INPH患者进行分析。纳入研究的患者（年龄在60 - 85岁之间且无痴呆，即简易精神状态检查≥23分）到其医疗服务提供者处进行标准化就诊，并回答一份详细问卷。年龄和性别匹配的基于人群的对照组接受相同程序。使用老年抑郁量表15评估抑郁症状（疑似抑郁症定义为≥5分，疑似重度抑郁症定义为≥12分）。本研究是INPH - CRasH研究的一部分。
176例INPH患者和368例对照参与研究。在对年龄、性别、脑血管疾病以及收缩压和舒张压进行调整后，患者的平均抑郁评分更高（患者：4.9±3.7标准差，对照：1.9±2.3标准差；比值比1.4，95%置信区间1.3 - 1.6，P <.001），更多患者有疑似抑郁症（46%对13%，比值比6.4，95%置信区间3.8 - 10.9，P <.001），更多患者有疑似重度抑郁症（7.3%对0.6%，比值比14.4，95%置信区间3.0 - 68.6，P <.005）。
与普通人群相比，尽管接受了分流治疗，INPH患者中抑郁症状的发病率仍过高。在评估INPH患者时应进行抑郁症筛查，以便发现并治疗并存的抑郁症。
