liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
Israelsson Larsen, HannaORCID iD iconorcid.org/0000-0002-0125-9589
Alternative names
Publications (10 of 12) Show all publications
Kadowaki, Å., Alvunger, A.-K., Israelsson Larsen, H., Persdotter, A., Zak, M. S., Johansson, P. & Nyström, F. H. (2021). Education of the primary health care staff based on acceptance and commitment therapy is associated with reduced sick leave in a prospective controlled trial. BMC Family Practice, 22(1), Article ID 179.
Open this publication in new window or tab >>Education of the primary health care staff based on acceptance and commitment therapy is associated with reduced sick leave in a prospective controlled trial
Show others...
2021 (English)In: BMC Family Practice, E-ISSN 1471-2296, Vol. 22, no 1, article id 179Article in journal (Refereed) Published
Abstract [en]

Background: The use of cognitive behavioral therapy (CBT) to cope with mental distress and pain issues has helped many patients in primary health care in Sweden. However, the effects of CBT to reduce sick leave has not been equally convincing. Acceptance and Commitment Therapy (ACT) is an evolution of traditional CBT and we aimed to study if education based on ACT of the staff rather than the patients could reduce sick leave in primary health care. Methods: This was a prospective trial in 6 primary health care centers in Kalmar (total amount of registered subjects of 28,930) in which the staff (physicians, nurses and therapists) received group-based education according to ACT during 2018 and 2019. The effects were compared with 5 similarly sized control health care centers in the neighboring Region of Jonkoping in which no such education took place. The main aim was to study changes in sick leave in the 6 primary care centers of Kalmar and to keep track of more general trends by studying sick leave also in Jonkoping, letting sick leave in the year 2017 to be the reference period for both areas. Results: The staff at the health care centers in Kalmar reported to having attended a mean of 5.2 +/- 2 educational ACT-sessions with psychiatrist Kadowaki in Kalmar. Sick leave for ICD-10 F43 (reaction to severe stress and related adjustment-disorders) was reduced from a mean value of 28.7 +/- 9.1ongoing sick leaves/month in 2017 to 22.6 +/- 7.0 sick leaves/month in 2018 (-21%, p = 0.033) and to 18.1 +/- 10 sick leaves/month in 2019 (-37%, p = 0.038). The corresponding sick leave for any diagnosis (total sick leave) was reduced from 132 +/- 39 sick leaves/month in 2017 to 118 +/- 38 sick leaves/month in 2018 (-11%, p = 0.056) and to 102 +/- 37 sick leaves/month in 2019 (-21%, p = 0.021). The corresponding sick leave comparisons in the control health centers did not show any significant changes (all p-values >= 0.24). Conclusions: Total monthly mean sick leave was reduced 21% in the health care centers in Kalmar during the second year of the educational ACT intervention of the staff while it was unchanged in Jonkoping. This suggests a significant effect to induce a reduction in long-term sick leave for patients in primary health care in which the staff received education according to ACT. The results of this trial could serve as a basis for a randomized trial in order to ascertain causality.

Place, publisher, year, edition, pages
BMC, 2021
Keywords
Acceptance and commitment therapy; Mental health; Musculoskeletal pain; Treatment efficacy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-179410 (URN)10.1186/s12875-021-01526-5 (DOI)000693808700001 ()34496751 (PubMedID)
Note

Funding Agencies|Linkoping University

Available from: 2021-09-21 Created: 2021-09-21 Last updated: 2022-02-10
Larsson, J., Israelsson, H., Eklund, A., Lundin-Olsson, L. & Malm, J. (2021). Falls and Fear of Falling in Shunted Idiopathic Normal Pressure Hydrocephalus-The Idiopathic Normal Pressure Hydrocephalus Comorbidity and Risk Factors Associated With Hydrocephalus Study. Neurosurgery, 89(1), 122-128
Open this publication in new window or tab >>Falls and Fear of Falling in Shunted Idiopathic Normal Pressure Hydrocephalus-The Idiopathic Normal Pressure Hydrocephalus Comorbidity and Risk Factors Associated With Hydrocephalus Study
Show others...
2021 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 89, no 1, p. 122-128Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Gait and balance impairment are typical symptoms of idiopathic normal pressure hydrocephalus (INPH), implicating that falls may afflict these patients. OBJECTIVE: To investigate falls, related injuries, and associated psychological features, before and after shunt surgery for INPH and compared to the general population. METHODS: The study included 176 patients shunted for INPH and 368 age- and sex-matched controls. Falls, fear of falling (FOF), fall-related injuries (mild-severe), confidence in avoiding falls (Swedish Falls Efficacy Scale (FES(S)), quality of life (QoL; EuroQoL 5-dimension 5 level instrument), and symptoms of depression (Geriatric Depression Scale 15) were investigated. Pre- and postoperative observational times were 12 mo before surgery and 21 mo after (mean). Recurrent fallers fell >= 2 times. RESULTS: More INPH patients than controls were recurrent fallers (67% vs 11%; P < .001). They feared falling more often (FOF, mean standard deviation: 3.3 +/- 1.1 vs 1.6 +/- 0.9; P < .001) and had lower confidence in avoiding falls (FES(S) 78 +/- 40 vs 126 +/- 14; P < .001). After surgery, INPH patients improved in all parameters but they did not reach the levels of the controls. Among fallers there was no difference between patients and controls in the severity of injuries suffered. Low QoL and symptoms of depression were more common among recurrent fallers than one-time or nonfallers in both shunted patients and controls (P <= .001). CONCLUSION: Falls, FOF, and low confidence in avoiding falls are considerable problems in INPH that may be reduced by shunt surgery. We suggest that remaining risk of falling and preventative measures are routinely considered in postoperative follow-ups and rehabilitation planning.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS INC, 2021
Keywords
Accidental falls; Case-control studies; Cognitive dysfunction; Depression; Gait disorders; neurologic; Ventriculoperitoneal shunt; Quality of life
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-179962 (URN)10.1093/neuros/nyab094 (DOI)000671548600056 ()33830219 (PubMedID)
Note

Funding Agencies|Umea University [7003576]; Vasterbotten County Council (ALF) [7003576]

Available from: 2021-10-08 Created: 2021-10-08 Last updated: 2021-12-09
Israelsson, H., Eklund, A. & Malm, J. (2020). Cerebrospinal Fluid Shunting Improves Long-Term Quality of Life in Idiopathic Normal Pressure Hydrocephalus. Neurosurgery, 86(4), 574-582
Open this publication in new window or tab >>Cerebrospinal Fluid Shunting Improves Long-Term Quality of Life in Idiopathic Normal Pressure Hydrocephalus
2020 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 86, no 4, p. 574-582Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The short- and long-term impact of cerebrospinal fluid shunting onquality of life (QoL) in idiopathic normal pressure hydrocephalus (INPH) is poorly understood.OBJECTIVE: To investigate QoL in shunted INPH patients compared to the population andto investigate which factors influence QoL in INPH.METHODS: INPH patients consecutively shunted in Sweden during 2008-2010 were scrutinized. Population-based controls were age- and sex-matched to the patients. Includedparticipants were thefollowing: 176 INPH patients and 368 controls. QoL was assessed usingthe EuroQol 5-dimension 5-level (EQ5D5L) instrument, which measures overall QoL andhealth status in 5 dimensions. Independency (accommodation and/or need for in-homecare) and comorbidities were assessed. Patients were followed up 6-45 mo after surgery(mean follow-up time: 21 mo).RESULTS: Shunting improved QoL (P < .001) and health status in all dimensions (P < .005).Shunted INPH patients had lower QoL than controls (P < .001). The patients’ health statusin mobility, self-care, daily activities, and anxiety/depression was worse than the controlsboth before and after surgery (P < .001). The main predictors of low QoL in INPH weresymptoms of depression (P < .001) and severity of gait disturbance (P = .001). Fewer INPHpatients than controls lived independently (45% vs 85%, P < .001). Time after shunting hadno influence on QoL.CONCLUSION: QoL remains improved in shunted INPH patients at a mean follow-up timeof 21 mo, but the patients do not reach the same QoL as the population. Symptoms ofdepression and severity of gait disturbance are the strongest predictors of low QoL in INPH.

Place, publisher, year, edition, pages
Ovid Technologies, 2020
Keywords
Case-control studies, Dementia, Depression, Follow-up studies, Hydrocephalus, INPH CRASH, Normal pressure, Quality of life
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-181721 (URN)10.1093/neuros/nyz297 (DOI)
Available from: 2021-12-08 Created: 2021-12-08 Last updated: 2021-12-09Bibliographically approved
Israelsson Larsen, H., Larsson, J., Eklund, A. & Malm, J. (2020). Risk factors, comorbidities, quality of life, and complications after surgery in idiopathic normal pressure hydrocephalus: review of the INPH-CRasH study. Neurosurgical Focus, 49(4), Article ID E8.
Open this publication in new window or tab >>Risk factors, comorbidities, quality of life, and complications after surgery in idiopathic normal pressure hydrocephalus: review of the INPH-CRasH study
2020 (English)In: Neurosurgical Focus, ISSN 1092-0684, Vol. 49, no 4, article id E8Article, review/survey (Refereed) Published
Abstract [en]

OBJECTIVE Idiopathic normal pressure hydrocephalus (INPH) is a dementia treatable by insertion of a shunt that drains CSF. The cause of the disease is unknown, but a vascular pathway has been suggested. The INPH-CRasH (Comorbidities and Risk Factors Associated with Hydrocephalus) study was a modern epidemiological case-control study designed to prospectively assess parameters regarding comorbidities and vascular risk factors (VRFs) for INPH, quality of life (QOL), and adverse events in patients with shunted INPH. The objective of this review was to summarize the findings of the INPH-CRasH study. METHODS VRFs, comorbidities, QOL, and adverse events were analyzed in consecutive patients with INPH who underwent shunt placement between 2008 and 2010 in 5 of 6 neurosurgical centers in Sweden. Patients (n = 176, within the age span of 60-85 years and not having dementia) were compared to population-based age- and gender-matched controls (n = 368, same inclusion criteria as for the patients with INPH). Assessed parameters were as follows: hypertension; diabetes; obesity; hyperlipidemia; psychosocial factors (stress and depression); smoking status; alcohol intake; physical activity; dietary pattern; cerebrovascular, cardiovascular, or peripheral vascular disease; epilepsy; abdominal pain; headache; and clinical parameters before and after surgery. Parameters were assessed through questionnaires, clinical examinations, measurements, ECG studies, and blood samples. RESULTS Four VRFs were independently associated with INPH: hyperlipidemia, diabetes, obesity, and psychosocial factors. Physical inactivity and hypertension were also associated with INPH, although not independently from the other risk factors. The population attributable risk percent for a model containing all of the VRFs associated with INPH was 24%. Depression was overrepresented in patients with INPH treated with shunts compared to the controls (46% vs 13%, p &lt; 0.001) and the main predictor for low QOL was a coexisting depression (p &lt; 0.001). Shunting improved QOL on a long-term basis. Epilepsy, headache, and abdominal pain remained common for a mean follow-up time of 21 months in INPH patients who received shunts. CONCLUSIONS The results of the INPH-CRasH study are consistent with a vascular pathophysiological component of INPH. In clinical care and research, a complete risk factor analysis as well as screening for depression and a measurement for QOL should probably be included in the workup of patients with INPH. The effect of targeted interventions against modifiable VRFs and antidepressant treatment in INPH patients should be evaluated. Seizures, headache, and abdominal pain should be inquired about at postoperative follow-up examinations.

Place, publisher, year, edition, pages
AMER ASSOC NEUROLOGICAL SURGEONS, 2020
Keywords
normal pressure hydrocephalus; vascular disease; vascular risk factors; outcome of surgery; adverse events; quality of life
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-171493 (URN)10.3171/2020.7.FOCUS20466 (DOI)000581702500008 ()33002861 (PubMedID)
Note

Funding Agencies|Swedish Research CouncilSwedish Research Council; Umea University; Vasterbotten County Council; research fund for clinical neuroscience at Umea University Hospital

Available from: 2020-11-19 Created: 2020-11-19 Last updated: 2023-03-27
Andrén, K., Wikkelsø, C., Sundström, N., Israelsson, H., Agerskov, S., Laurell, K., . . . Tullberg, M. (2020). Survival in treated idiopathic normal pressure hydrocephalus. Journal of Neurology, 267(3), 640-648
Open this publication in new window or tab >>Survival in treated idiopathic normal pressure hydrocephalus
Show others...
2020 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 267, no 3, p. 640-648Article in journal (Refereed) Published
Abstract [en]

Objective: To describe survival and causes of death in 979 treated iNPH patients from the Swedish Hydrocephalus Quality Registry (SHQR), and to examine the influence of comorbidities, symptom severity and postoperative outcome.

Methods: All 979 patients operated for iNPH 2004–2011 and registered in the SHQR were included. A matched control group of 4890 persons from the general population was selected by Statistics Sweden. Data from the Swedish Cause of Death Registry was obtained for patients and controls.

Results: At a median 5.9 (IQR 4.2–8.1) year follow-up, 37% of the iNPH patients and 23% of the controls had died. Mortality was increased in iNPH patients by a hazard ratio of 1.81, 95% CI 1.61–2.04, p < 0.001. More pronounced symptoms in the preoperative ordinal gait scale and the Mini-mental State Examination were the most important independent predictors of mortality along with the prevalence of heart disease. Patients who improved in both the gait scale and in the modified Rankin Scale postoperatively (n = 144) had a similar survival as the general population (p = 0.391). Deaths due to cerebrovascular disease or dementia were more common in iNPH patients, while more controls died because of neoplasms or disorders of the circulatory system.

Conclusions: Mortality in operated iNPH patients is 1.8 times increased compared to the general population, a lower figure than previously reported. The survival of iNPH patients who improve in gait and functional independence is similar to that of the general population, indicating that shunt surgery for iNPH, besides improving symptoms and signs, can normalize survival.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2020
Keywords
Hydrocephalus, Gait disorders, Cognitive disorders, Prognosis, Cohort studies
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-181729 (URN)10.1007/s00415-019-09598-1 (DOI)000495682300002 ()31713102 (PubMedID)2-s2.0-85075162415 (Scopus ID)
Available from: 2021-12-09 Created: 2021-12-09 Last updated: 2022-01-12
Larsson, J., Israelsson, H., Eklund, A. & Malm, J. (2018). Epilepsy, headache, and abdominal pain after shunt surgery for idiopathic normal pressure hydrocephalus: the INPH-CRasH study. Journal of Neurosurgery, 128(6), 1674-1683
Open this publication in new window or tab >>Epilepsy, headache, and abdominal pain after shunt surgery for idiopathic normal pressure hydrocephalus: the INPH-CRasH study
2018 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 128, no 6, p. 1674-1683Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE Adverse events related to shunt surgery are common and might have a negative effect on outcome in patients with idiopathic normal pressure hydrocephalus (INPH). The authors' objectives were to establish the frequencies of epilepsy, headache, and abdominal pain and determine their impact on patient quality of life (QOL), in long-term follow-up after shunt surgery for INPH.

METHODS One hundred seventy-six shunt-treated patients with INPH (mean age 74 years) and 368 age- and sex-matched controls from the population were included. The mean follow-up time after surgery was 21 months (range 6-45 months). Each participant answered a questionnaire regarding present frequency and severity of headache and abdominal pain. Confirmed diagnoses of epilepsy and all prescriptions for antiepileptic drugs (AEDs) before and after shunt surgery for INPH were gathered from national registries. Equivalent presurgical and postsurgical time periods were constructed for the controls based on the date of surgery (the division date for controls is referred to as virtual surgery). All registry data covered a mean period of 6 years (range 3-8 years) before surgery/virtual surgery and 4 years (range 2-6 years) after surgery/virtual surgery. Provoked epileptic seizures were excluded. Patient QOL was assessed with the EuroQoL 5-dimension 5-level instrument.

RESULTS Epilepsy was more common in shunt-treated patients with INPH than in controls (4.5% vs 1.1%, respectively; p = 0.023), as was treatment with AEDs (14.8% vs 7.3%, respectively; p = 0.010). No difference was found between the populations before surgery/virtual surgery (epilepsy, 2.3% [INPH] vs 1.1% [control], p = 0.280; AED treatment, 8.5% [INPH] vs 5.4% [control], p = 0.235). New-onset epilepsy and new AED treatment after surgery/virtual surgery were more common in INPH (epilepsy, 2.3% [INPH] vs 0.0% [control], p = 0.011; AED, 8.5% [INPH] vs 3.3% [control], p = 0.015). At follow-up, more patients with INPH than controls experienced headache several times per month or more often (36.1% vs 11.6%, respectively; p < 0.001). Patients with INPH and unilateral headache had more right-sided headaches than controls (p = 0.038). Postural headache was experienced by 16% (n = 27 of 169) of the patients with INPH. Twenty percent (n = 35) of the patients with INPH had persistent abdominal pain. Headache was not correlated to lower QOL. The study was underpowered to draw conclusions regarding QOL in patients with INPH who had epilepsy and abdominal pain, but the finding of no net difference in mean QOL indicates that no correlation between them existed.

CONCLUSIONS Epilepsy, headache, and abdominal pain are common in long-term follow-up in patients after shunt surgery for INPH and are more common among patients with INPH than in the general population. All adverse events, including mild and moderate ones, should be considered during postoperative follow-ups and in the development of new methods for shunt placement.

Place, publisher, year, edition, pages
Rolling Meadows: American association of neurological surgeons, 2018
Keywords
hydrocephalus, normal pressure, ventriculoperitoneal shunt, postoperative complications, headache, epilepsy, abdominal pain
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-181730 (URN)10.3171/2017.3.JNS162453 (DOI)000440653000010 ()28885121 (PubMedID)
Available from: 2017-09-19 Created: 2021-12-09 Last updated: 2021-12-09
Andrén, K., Wikkelsö, C., Sundström, N., Agerskov, S., Israelsson, H., Laurell, K., . . . Tullberg, M. (2018). Long-term effects of complications and vascular comorbidity in idiopathic normal pressure hydrocephalus: a quality registry study. Journal of Neurology, 265(1), 178-186
Open this publication in new window or tab >>Long-term effects of complications and vascular comorbidity in idiopathic normal pressure hydrocephalus: a quality registry study
Show others...
2018 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 265, no 1, p. 178-186Article in journal (Refereed) Published
Abstract [en]

Background: There is little knowledge about the factors influencing the long-term outcome after surgery for idiopathic normal pressure hydrocephalus (iNPH).

Objective: To evaluate the effects of reoperation due to complications and of vascular comorbidity (hypertension, diabetes, stroke and heart disease) on the outcome in iNPH patients, 2–6 years after shunt surgery.

Methods: We included 979 patients from the Swedish Hydrocephalus Quality Registry (SHQR), operated on for iNPH during 2004–2011. The patients were followed yearly by mailed questionnaires, including a self-assessed modified Rankin Scale (smRS) and a subjective comparison between their present and their preoperative health condition. The replies were grouped according to the length of follow-up after surgery. Data on clinical evaluations, vascular comorbidity, and reoperations were extracted from the SHQR.

Results: On the smRS, 40% (38–41) of the patients were improved 2–6 years after surgery and around 60% reported their general health condition to be better than preoperatively. Reoperation did not influence the outcome after 2–6 years. The presence of vascular comorbidity had no negative impact on the outcome after 2–6 years, assessed as improvement on the smRS or subjective improvement of the health condition, except after 6 years when patients with hypertension and a history of stroke showed a less favorable development on the smRS.

Conclusion: This registry-based study shows no negative impact of complications and only minor effects of vascular comorbidity on the long-term outcome in iNPH.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
hydrocephalus, normal pressure, dementia, gait, complications, concomitant disease, risk factors, registries
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-192718 (URN)10.1007/s00415-017-8680-z (DOI)000419777000023 ()29188384 (PubMedID)2-s2.0-85035324543 (Scopus ID)
Available from: 2023-03-27 Created: 2023-03-27 Last updated: 2023-04-17
Bäcklund, T., Frankel, J., Israelsson, H., Malm, J. & Sundström, N. (2017). Trunk sway in idiopathic normal pressure hydrocephalus-Quantitative assessment in clinical practice. Gait & Posture, 54, 62-70
Open this publication in new window or tab >>Trunk sway in idiopathic normal pressure hydrocephalus-Quantitative assessment in clinical practice
Show others...
2017 (English)In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 54, p. 62-70Article in journal (Refereed) Published
Abstract [en]

In diagnosis and treatment of patients with idiopathic normal pressure hydrocephalus (iNPH), there is need for clinically applicable, quantitative assessment of balance and gait. Using a body-worn gyroscopic system, the aim of this study was to assess postural stability of iNPH patients in standing, walking and during sensory deprivation before and after cerebrospinal fluid (CSF) drainage and surgery. A comparison was performed between healthy elderly (HE) and patients with various types of hydrocephalus (ventriculomegaly (VM)).

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Balance; Gait; Gyroscope; Idiopathic normal pressure hydrocephalus; Trunk sway
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-145289 (URN)10.1016/j.gaitpost.2017.02.017 (DOI)000405044400011 ()28259041 (PubMedID)
Available from: 2018-02-23 Created: 2018-02-23 Last updated: 2021-12-09
Israelsson, H., Carlberg, B., Wikkelso, C., Laurell, K., Kahlon, B., Leijon, G., . . . Malm, J. (2017). Vascular risk factors in INPH A prospective case- control study (the INPH-CRasH study). Neurology, 88(6), 577-585
Open this publication in new window or tab >>Vascular risk factors in INPH A prospective case- control study (the INPH-CRasH study)
Show others...
2017 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 88, no 6, p. 577-585Article in journal (Refereed) Published
Abstract [en]

Objective: To assess the complete vascular risk factor (VRF) profile of idiopathic normal pressure hydrocephalus (INPH) using a large sample of representative patients with INPH and populationbased controls to determine the extent to which vascular disease influences INPH pathophysiology. Methods: All patients with INPH who underwent shunting in Sweden in 2008-2010 were compared to age-and sex-matched population-based controls. Inclusion criteria were age 60-85 years and no dementia. The 10 most important VRFs and cerebrovascular and peripheral vascular disease were prospectively assessed using blood samples, clinical examinations, and standardized questionnaires. Assessed VRFs were hypertension, hyperlipidemia, diabetes, obesity, psychosocial factors, smoking habits, diet, alcohol intake, cardiac disease, and physical activity. Results: In total, 176 patients with INPH and 368 controls participated. Multivariable logistic regression analysis indicated that hyperlipidemia (odds ratio [OR] 2.380; 95% confidence interval [CI] 1.434-3.950), diabetes (OR 2.169; 95% CI 1.195-3.938), obesity (OR 5.428; 95% CI 2.502-11.772), and psychosocial factors (OR 5.343; 95% CI 3.219-8.868) were independently associated with INPH. Hypertension, physical inactivity, and cerebrovascular and peripheral vascular disease were also overrepresented in INPH. Moderate alcohol intake and physical activity were overrepresented among the controls. The population-attributable risk percentage was 24%. Conclusions: Our findings confirm that patients with INPH have more VRFs and lack the protective factors present in the general population. Almost 25% of cases of INPH may be explained by VRFs. This suggests that INPH may be a subtype of vascular dementia. Targeted interventions against modifiable VRFs are likely to have beneficial effects on INPH.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2017
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-136314 (URN)10.1212/WNL.0000000000003583 (DOI)000397342100013 ()
Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2021-12-09
Israelsson, H., Allard, P., Eklund, A. & Malm, J. (2016). Symptoms of Depression are Common in Patients With Idiopathic Normal Pressure Hydrocephalus: The INPH-CRasH Study. Neurosurgery, 78(2), 161-168
Open this publication in new window or tab >>Symptoms of Depression are Common in Patients With Idiopathic Normal Pressure Hydrocephalus: The INPH-CRasH Study
2016 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 78, no 2, p. 161-168Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: 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.

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.

Keywords
Case-control studies, Dementia, Depression, Depressive disorder, Follow-up studies, GDS 15, drocephalus, Normal pressure
National Category
Psychiatry Geriatrics
Identifiers
urn:nbn:se:liu:diva-181732 (URN)10.1227/NEU.0000000000001093 (DOI)000368585600001 ()26528670 (PubMedID)
Available from: 2016-02-19 Created: 2021-12-09
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0125-9589

Search in DiVA

Show all publications