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

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Risk factors, comorbidities, quality of life, and complications after surgery in idiopathic normal pressure hydrocephalus: review of the INPH-CRasH study
Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Umea Univ, Sweden.ORCID iD: 0000-0002-0125-9589
Umea Univ, Sweden.
Umea Univ, Sweden.
Umea Univ, Sweden.
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 < 0.001) and the main predictor for low QOL was a coexisting depression (p < 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. Vol. 49, no 4, article id E8
Keywords [en]
normal pressure hydrocephalus; vascular disease; vascular risk factors; outcome of surgery; adverse events; quality of life
National Category
Neurology
Identifiers
URN: urn:nbn:se:liu:diva-171493DOI: 10.3171/2020.7.FOCUS20466ISI: 000581702500008PubMedID: 33002861OAI: oai:DiVA.org:liu-171493DiVA, id: diva2:1502317
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

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records

Israelsson Larsen, Hanna

Search in DiVA

By author/editor
Israelsson Larsen, Hanna
By organisation
Faculty of Medicine and Health SciencesPrimary Health Care Center Cityhälsan CentrumDivision of Prevention, Rehabilitation and Community Medicine
In the same journal
Neurosurgical Focus
Neurology

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 34 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf