Neurology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.
Algoritmi Centre, School of Engineering, University of Minho, Portugal; Centre of Mathematics, School of Sciences, University of Minho, Portugal.
Clin Neurol Neurosurg. 2022 Oct;221:107405. doi: 10.1016/j.clineuro.2022.107405. Epub 2022 Aug 2.
Shunt surgery (SS) remains the most effective treatment for idiopathic Normal pressure hydrocephalus (iNPH), but the selection of the patients with the greatest potential benefit remains elusive.
Identify gait features predictive of best response to SS in iNPH.
Eight patients with iNPH were assessed at baseline, after Cerebrospinal fluid tap-test (CSF-TT) and SS, with clinical scales (Clinical/Patient Global Clinical Impression, EuroQol-5D, Clinical Dementia Rating Scale(CDR), MoCA test, Hoehn-Yahr Scale) and gait analysis with inertial sensors.
The 8 included iNPH patients had a mean age of 73 years(59-81), moderate cognitive (CDR-1.5 (0.5-2); MoCA-9.5 (3-21)) and motor impairment (Hoehn-Yahr-2.75(2-3)). After SS, patients had a significant improvement in cognition (MoCA, p = 0.001) and quality of life. At baseline, patients with lower improvement (no change/ minimally improved) (n = 2), in comparison to patient with higher improvement (much/very much improved) (n = 6), already had higher cognitive impairment (MoCa-3(3-3) vs. 11(7-21)). Patients with lower improvement had a lower % of change in gait performance at LP (mean 10.2 %) and were absent of additional benefit after SS(mean -0.8 %). In contrast, gait performance in patients with higher improvement consistently got better from baseline to LP (mean 23.1 %) and from baseline to SS (mean 82.9 %). A significant negative correlation was observed between CDR score and several gait variables: speed (r=-0.92,p = 0.009); stride length (r=-0.92,p = 0.009); lift-off angle (r=-0.96,p = 0.003); and maximum heel (r=-0.81,p = 0.049).
The magnitude of gait improvement after CSF-TT, quantified by gait analysis, can be used as an integral variable in the multimodal clinical approach to the prediction of improvement after SS.
分流手术（SS）仍然是治疗特发性正常压力脑积水（iNPH）最有效的方法，但选择获益最大的患者仍然难以捉摸。
确定预测 iNPH 患者对 SS 最佳反应的步态特征。
8 例 iNPH 患者在基线时、CSF tapp 测试（CSF-TT）后和 SS 后进行评估，采用临床量表（临床/患者总体临床印象、EuroQol-5D、临床痴呆评定量表（CDR）、蒙特利尔认知评估量表（MoCA）测试、Hoehn-Yahr 量表）和惯性传感器进行步态分析。
8 例纳入的 iNPH 患者平均年龄 73 岁（59-81 岁），认知功能中度受损（CDR-1.5（0.5-2）；MoCA-9.5（3-21））和运动障碍（Hoehn-Yahr-2.75（2-3））。SS 后，患者认知功能（MoCA，p=0.001）和生活质量均有显著改善。在基线时，与认知功能改善更高（明显/非常明显改善）的患者（n=6）相比，认知功能改善较低（无变化/轻度改善）的患者（n=2）已经有更高的认知障碍（MoCa-3（3-3）比 11（7-21））。认知功能改善较低的患者在 LP 时的步态表现改善百分比较低（平均 10.2%），并且 SS 后没有额外获益（平均-0.8%）。相比之下，认知功能改善更高的患者的步态表现从基线到 LP（平均 23.1%）和从基线到 SS（平均 82.9%）都有所改善。CDR 评分与几个步态变量呈显著负相关：速度（r=-0.92，p=0.009）；步长（r=-0.92，p=0.009）；离地角度（r=-0.96，p=0.003）；和最大脚跟（r=-0.81，p=0.049）。
CSF-TT 后步态改善的幅度，通过步态分析量化，可以作为 SS 后预测改善的多模态临床方法的一个综合变量。
