Rakuwa Villa Ilios, Kyoto, Kyoto, Japan.
Normal Pressure Hydrocephalus Centre, Otowa Hospital, Kyoto, Kyoto, Japan.
Sci Rep. 2021 Jun 3;11(1):11732. doi: 10.1038/s41598-021-90911-2.
Idiopathic normal pressure hydrocephalus (iNPH) is a surgically treatable syndrome commonly observed in older adults. However, it is unclear whether clinical improvements after surgery can effectively reduce the long-term care burden (LTCB). In this study, we determined whether shunt surgery was effective in decreasing LTCB. We also investigated the degree of variability in patients and hospitals, using data from the iNPH multicenter study. This study involved 69 participants who underwent lumboperitoneal shunt surgery with follow-up for 12 months. A generalized linear mixed model was applied to analyze the fixed and random effects simultaneously. Regarding LTCB, the disability grades improved significantly. Although the dementia grades also improved, it was not statistically significant. The differences in the LTCB grades in most patients were within the range of the 95% confidence intervals, while in the case of hospitals, some were often out of the range. Further studies are needed to improve dementia in patients with iNPH. The incorporation of random variables, such as hospitals, is important for the analysis of data from multicenter studies.
特发性正常压力脑积水(iNPH)是一种常见于老年人的可通过手术治疗的综合征。然而,手术后的临床改善是否能有效地减轻长期护理负担(LTCB)尚不清楚。在这项研究中,我们确定分流手术是否能有效降低 LTCB。我们还使用 iNPH 多中心研究的数据,调查了患者和医院之间的变异性程度。这项研究涉及 69 名接受腰椎腹膜分流手术的患者,随访时间为 12 个月。采用广义线性混合模型同时分析固定效应和随机效应。关于 LTCB,残疾程度显著改善。虽然痴呆程度也有所改善,但没有统计学意义。大多数患者的 LTCB 等级差异在 95%置信区间范围内,而对于医院,有些则经常超出范围。需要进一步研究以改善 iNPH 患者的痴呆状况。对于多中心研究的数据,纳入随机变量(如医院)进行分析很重要。