Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Biomedical and Clinical Sciences, Neurobiology, Linköping University, Linköping, Sweden.
J Neurol. 2024 Jun;271(6):3215-3226. doi: 10.1007/s00415-024-12248-w. Epub 2024 Mar 5.
To determine the utility of symptoms, signs, comorbidities and background variables for the prediction of outcome of treatment in iNPH.
A prospective observational study of consecutively included iNPH patients, who underwent neurological, physiotherapeutic and neuropsychological assessments before and after shunt surgery. The primary outcome measure was the total change on the iNPH scale, and patients were defined as improved postoperatively if they had improved by at least five points on that scale.
143 iNPH patients were included, and 73% of those were improved after surgery. None of the examined symptoms or signs could predict which patients would improve after shunt surgery. A dominant subjective complaint of memory problems at baseline was predictive of non-improvement. The reported comorbidities, duration of symptoms and BMI were the same in improved and non-improved patients. Each of the symptom domains (gait, neuropsychology, balance, and continence) as well as the total iNPH scale score improved significantly (from median 53 to 69, p < 0.001). The proportions of patients with shuffling gait, broad-based gait, paratonic rigidity and retropulsion all decreased significantly.
This study confirms that the recorded clinical signs, symptoms, and impairments in the adopted clinical tests are characteristic findings in iNPH, based on that most of them improved after shunt surgery. However, our clinical data did not enable predictions of whether patients would respond to shunt surgery, indicating that the phenotype is unrelated to the reversibility of the iNPH state and should mainly support diagnosis. Absence of specific signs should not be used to exclude patients from treatment.
确定症状、体征、合并症和背景变量对 iNPH 治疗结果的预测价值。
这是一项连续纳入 iNPH 患者的前瞻性观察性研究，这些患者在分流手术前后接受了神经学、物理治疗和神经心理学评估。主要结局测量指标是 iNPH 量表的总变化，术后如果患者在该量表上至少提高了 5 分，则定义为改善。
共纳入 143 例 iNPH 患者，其中 73%的患者术后得到改善。在接受分流手术的患者中，没有任何检查到的症状或体征可以预测哪些患者会改善。基线时以记忆问题为主诉的主观抱怨是预测非改善的指标。报告的合并症、症状持续时间和 BMI 在改善和未改善的患者中相同。改善和未改善的患者的步态、神经心理学、平衡和尿失禁等各个症状域以及 iNPH 量表总分均显著改善（中位数从 53 分提高至 69 分，p<0.001）。蹒跚步态、宽基步态、张力障碍和后冲的患者比例均显著下降。
本研究证实，所采用的临床测试中记录的临床体征、症状和损伤是 iNPH 的特征性发现，大多数患者在接受分流手术后得到改善。然而，我们的临床数据无法预测患者是否对分流手术有反应，这表明表型与 iNPH 状态的可逆性无关，主要应支持诊断。没有特定的体征不应被用来排除接受治疗的患者。
