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Background Risk Factors Associated with Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus: A Nationwide Hospital-Based Survey in Japan

BACKGROUND: Patients with idiopathic normal-pressure hydrocephalus (iNPH) are typically older adults with multiple comorbidities that are associated with a reduction in the efficacy of iNPH treatment via cerebrospinal fluid (CSF) shunt placement. OBJECTIVE: The present study aimed to investigate the...

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Autores principales: Nakajima, Madoka, Kuriyama, Nagato, Miyajima, Masakazu, Ogino, Ikuko, Akiba, Chihiro, Kawamura, Kaito, Kurosawa, Michiko, Watanabe, Yoshiyuki, Fukushima, Wakaba, Mori, Etsuro, Kato, Takeo, Sugano, Hidenori, Tange, Yuichi, Karagiozov, Kostadin, Arai, Hajime
Formato: Online Artículo Texto
Lenguaje:English
Publicado: IOS Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484254/
https://www.ncbi.nlm.nih.gov/pubmed/30883349
http://dx.doi.org/10.3233/JAD-180955
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author Nakajima, Madoka
Kuriyama, Nagato
Miyajima, Masakazu
Ogino, Ikuko
Akiba, Chihiro
Kawamura, Kaito
Kurosawa, Michiko
Watanabe, Yoshiyuki
Fukushima, Wakaba
Mori, Etsuro
Kato, Takeo
Sugano, Hidenori
Tange, Yuichi
Karagiozov, Kostadin
Arai, Hajime
author_facet Nakajima, Madoka
Kuriyama, Nagato
Miyajima, Masakazu
Ogino, Ikuko
Akiba, Chihiro
Kawamura, Kaito
Kurosawa, Michiko
Watanabe, Yoshiyuki
Fukushima, Wakaba
Mori, Etsuro
Kato, Takeo
Sugano, Hidenori
Tange, Yuichi
Karagiozov, Kostadin
Arai, Hajime
author_sort Nakajima, Madoka
collection PubMed
description BACKGROUND: Patients with idiopathic normal-pressure hydrocephalus (iNPH) are typically older adults with multiple comorbidities that are associated with a reduction in the efficacy of iNPH treatment via cerebrospinal fluid (CSF) shunt placement. OBJECTIVE: The present study aimed to investigate the effectiveness of CSF shunt for iNPH using data from a nationwide epidemiological survey in Japan. METHODS: We examined 1,423 patients (581 women) aged ≥60 years (median age [25%–75%]: 77 [73–80] years) who were diagnosed with iNPH following a hospital visit in 2012. Patients who experienced an improvement of at least one modified Rankin Scale (mRS) grade after the CSF shunt were classified as “improvement” while the remaining patients were classified as “non-improvement.” The efficacy of the shunt intervention (n = 842) was analyzed using a binomial logistic regression analysis. RESULTS: An analysis of risk factors associated with shunt placement in patients with mRS grade 2 revealed an association between comorbid chronic ischemic lesions (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11–4.67; p = 0.025) and cervical spondylosis (OR, 3.62; 95% CI, 1.15–11.34; p = 0.027). Patients with mRS grade 3 at study entry had an association with comorbid Alzheimer’s disease (OR, 3.02; 95% CI, 1.44–6.31; p = 0.003). CONCLUSIONS: The results presented here showed that any age-related risk is minimal and should not be cause for rejection of surgical treatment options. Clinical decisions regarding CSF shunt should be individualized to each patient, with adequate consideration of the relative risks and benefits, including maximizing a healthy life expectancy.
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spelling pubmed-64842542019-05-13 Background Risk Factors Associated with Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus: A Nationwide Hospital-Based Survey in Japan Nakajima, Madoka Kuriyama, Nagato Miyajima, Masakazu Ogino, Ikuko Akiba, Chihiro Kawamura, Kaito Kurosawa, Michiko Watanabe, Yoshiyuki Fukushima, Wakaba Mori, Etsuro Kato, Takeo Sugano, Hidenori Tange, Yuichi Karagiozov, Kostadin Arai, Hajime J Alzheimers Dis Research Article BACKGROUND: Patients with idiopathic normal-pressure hydrocephalus (iNPH) are typically older adults with multiple comorbidities that are associated with a reduction in the efficacy of iNPH treatment via cerebrospinal fluid (CSF) shunt placement. OBJECTIVE: The present study aimed to investigate the effectiveness of CSF shunt for iNPH using data from a nationwide epidemiological survey in Japan. METHODS: We examined 1,423 patients (581 women) aged ≥60 years (median age [25%–75%]: 77 [73–80] years) who were diagnosed with iNPH following a hospital visit in 2012. Patients who experienced an improvement of at least one modified Rankin Scale (mRS) grade after the CSF shunt were classified as “improvement” while the remaining patients were classified as “non-improvement.” The efficacy of the shunt intervention (n = 842) was analyzed using a binomial logistic regression analysis. RESULTS: An analysis of risk factors associated with shunt placement in patients with mRS grade 2 revealed an association between comorbid chronic ischemic lesions (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11–4.67; p = 0.025) and cervical spondylosis (OR, 3.62; 95% CI, 1.15–11.34; p = 0.027). Patients with mRS grade 3 at study entry had an association with comorbid Alzheimer’s disease (OR, 3.02; 95% CI, 1.44–6.31; p = 0.003). CONCLUSIONS: The results presented here showed that any age-related risk is minimal and should not be cause for rejection of surgical treatment options. Clinical decisions regarding CSF shunt should be individualized to each patient, with adequate consideration of the relative risks and benefits, including maximizing a healthy life expectancy. IOS Press 2019-03-29 /pmc/articles/PMC6484254/ /pubmed/30883349 http://dx.doi.org/10.3233/JAD-180955 Text en © 2019 – IOS Press and the authors. All rights reserved https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) License (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research Article
Nakajima, Madoka
Kuriyama, Nagato
Miyajima, Masakazu
Ogino, Ikuko
Akiba, Chihiro
Kawamura, Kaito
Kurosawa, Michiko
Watanabe, Yoshiyuki
Fukushima, Wakaba
Mori, Etsuro
Kato, Takeo
Sugano, Hidenori
Tange, Yuichi
Karagiozov, Kostadin
Arai, Hajime
Background Risk Factors Associated with Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus: A Nationwide Hospital-Based Survey in Japan
title Background Risk Factors Associated with Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus: A Nationwide Hospital-Based Survey in Japan
title_full Background Risk Factors Associated with Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus: A Nationwide Hospital-Based Survey in Japan
title_fullStr Background Risk Factors Associated with Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus: A Nationwide Hospital-Based Survey in Japan
title_full_unstemmed Background Risk Factors Associated with Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus: A Nationwide Hospital-Based Survey in Japan
title_short Background Risk Factors Associated with Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus: A Nationwide Hospital-Based Survey in Japan
title_sort background risk factors associated with shunt intervention for possible idiopathic normal pressure hydrocephalus: a nationwide hospital-based survey in japan
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484254/
https://www.ncbi.nlm.nih.gov/pubmed/30883349
http://dx.doi.org/10.3233/JAD-180955
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