By Jessica Moser
There are many studies that compare the symptomatic outcomes of individuals with idiopathic Normal Pressure Hydrocephalus, or iNPH, a type of hydrocephalus that typically affects older adults. Idiopathic NPH is typically characterized by several symptoms such as gait changes, dementia, and incontinence. In a 2019 Swedish study titled “Cerebrospinal Fluid Shunting Improves Long-Term Quality of Life in Idiopathic Normal Pressure Hydrocephalus” by Hanna Israelsson Md., PhD. from the Congress of Neurological Surgeons, 176 individuals with iNPH and 368 people without iNPH were asked about their quality of life through self-report questionnaires. For those diagnosed, particular attention was paid to their quality of life (QoL) before and after shunting.
WHAT THEY DID
The patients in the study were between 60-85 years old and that scored highly on a questionnaire that determined cognitive functioning, as those patients with low cognitive functioning could not give reliable answers about their QoL. When patients visited their physicians, they were given a survey to determine their QoL currently, and they were asked to rate their perceived QoL one year prior to shunting. The surveys were given an average of 21 months after being shunted. The patients ranked five aspects of their life: mobility, self care, usual activities, anxiety/depression, and pain/discomfort. For a control group, the study chose four people that matched closest in age and sex to each patient in the study from the Swedish population register.
WHAT THEY FOUND
Prior to being shunted, patients reported a lowered QoL than the control group. After being shunted, patients reported an increase in their overall QoL. The data shows that 72 to 75 percent of iNPH patients saw improved QoL after shunting. These findings were not dependent on when the surveys were administered after the procedure.
However, QoL for iNPH patients still ranked worse than the control groups in all but the pain/discomfort category of the given survey. They also were significantly more likely to need assistance at home compared to the control group.
Symptoms of depression were the main predictors of lower QoL in patients with iNPH. This is not unexpected as depression has also been found to predict low QoL in other similarly aged populations. How severe the gait problems were and whether a person can live independently also greatly affected their QoL ratings.
WHAT DO OTHER STUDIES SAY?
Numerous studies have been conducted about the overall change in QoL a person experiences after being diagnosed with iNPH, including whether receiving a shunt improves their QoL. Many report improvements in gait and physical functioning, but there are mixed results regarding other factors such as independence and cognitive functioning. A 2015 study from the European Journal of Neurology has data that agrees with this more recent study, that although people with iNPH have lower QoL scores than those without iNPH, they still show marked improvement from those who have the condition and aren’t shunted.
On the other hand, a 2011 study from the Journal of Clinical Neuroscience found that after shunting, many patients showed more favorable results and were able to get back to their regular activities such as driving and working. It also reported that 81 percent of people surveyed had improved gait. Another study from the Oxford Academic Neurosurgery Journal from 2011 reported better QoL for both the patient and the caregiver after being shunted. Overall, most studies report improvements in at least physical functioning after a person with iNPH has been shunted.