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Malm, Jan, ProfessorORCID iD iconorcid.org/0000-0001-6451-1940
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Publications (10 of 143) Show all publications
Björnfot, C., Eklund, A., Larsson, J., Hansson, W., Birnefeld, J., Garpebring, A., . . . Wåhlin, A. (2024). Cerebral arterial stiffness is linked to white matter hyperintensities and perivascular spaces in older adults: a 4D flow MRI study. Journal of Cerebral Blood Flow and Metabolism
Open this publication in new window or tab >>Cerebral arterial stiffness is linked to white matter hyperintensities and perivascular spaces in older adults: a 4D flow MRI study
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2024 (English)In: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016Article in journal (Refereed) Epub ahead of print
Abstract [en]

White matter hyperintensities (WMH), perivascular spaces (PVS) and lacunes are common MRI features of small vessel disease (SVD). However, no shared underlying pathological mechanism has been identified. We investigated whether SVD burden, in terms of WMH, PVS and lacune status, was related to changes in the cerebral arterial wall by applying global cerebral pulse wave velocity (gcPWV) measurements, a newly described marker of cerebral vascular stiffness. In a population-based cohort of 190 individuals, 66–85 years old, SVD features were estimated from T1-weighted and FLAIR images while gcPWV was estimated from 4D flow MRI data. Additionally, the gcPWV’s stability to variations in field-of-view was analyzed. The gcPWV was 10.82 (3.94) m/s and displayed a significant correlation to WMH and white matter PVS volume (r = 0.29, p < 0.001; r = 0.21, p = 0.004 respectively from nonparametric tests) that persisted after adjusting for age, blood pressure variables, body mass index, ApoB/A1 ratio, smoking as well as cerebral pulsatility index, a previously suggested early marker of SVD. The gcPWV displayed satisfactory stability to field-of-view variations. Our results suggest that SVD is accompanied by changes in the cerebral arterial wall that can be captured by considering the velocity of the pulse wave transmission through the cerebral arterial network.

Place, publisher, year, edition, pages
Sage Publications, 2024
Keywords
4D flow MRI, cerebral small vessel disease, perivascular spaces, pulse wave velocity, white matter hyperintensities
National Category
Cardiac and Cardiovascular Systems Neurology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-221120 (URN)10.1177/0271678X241230741 (DOI)001157963000001 ()38315044 (PubMedID)2-s2.0-85184419786 (Scopus ID)
Funder
Swedish Foundation for Strategic Research, RMX18-0152Swedish Heart Lung Foundation, 20180513Swedish Heart Lung Foundation, 20210653The Swedish Brain Foundation, F2022-0216Swedish Research Council, 2017-04949Swedish Research Council, 2022-04263Region Västerbotten
Available from: 2024-02-22 Created: 2024-02-22 Last updated: 2024-02-22
Birnefeld, J., Petersson, K., Wåhlin, A., Eklund, A., Birnefeld, E., Qvarlander, S., . . . Zarrinkoob, L. (2024). Cerebral blood flow assessed with phase-contrast magnetic resonance imaging during blood pressure changes with noradrenaline and labetalol: a trial in healthy volunteers . Anesthesiology, 140(4), 669-678
Open this publication in new window or tab >>Cerebral blood flow assessed with phase-contrast magnetic resonance imaging during blood pressure changes with noradrenaline and labetalol: a trial in healthy volunteers 
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2024 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 140, no 4, p. 669-678Article in journal (Refereed) Published
Abstract [en]

Background: Adequate cerebral perfusion is central during general anesthesia. However, perfusion is not readily measured bedside. Clinicians currently rely mainly on MAP as a surrogate even though the relationship between blood pressure and cerebral blood flow is not well understood. The aim of this study was to apply phase contrast MRI to characterize blood flow responses in healthy volunteers to commonly used pharmacological agents that increase or decrease arterial blood pressure.

Methods: Eighteen healthy volunteers aged 30-50 years were investigated with phase contrast MRI. Intraarterial blood pressure monitoring was used. First, intravenous noradrenaline was administered to a target MAP of 20% above baseline. After a wash-out period, intravenous labetalol was given to a target MAP of 15% below baseline. Cerebral blood flow was measured using phase contrast MRI and defined as the sum of flow in the internal carotid arteries and vertebral arteries. CO was defined as the flow in the ascending aorta.

Baseline median cerebral blood flow was 772 ml/min (interquartile range, 674 to 871), and CO was 5,874 ml/min (5,199 to 6,355). The median dose of noradrenaline was 0.17 µg · kg−1 · h−1 (0.14 to 0.22). During noradrenaline infusion, cerebral blood flow decreased to 705 ml/min (606 to 748; P = 0.001), and CO decreased to 4,995 ml/min (4,705 to 5,635; P = 0.01). A median dose of labetalol was 120 mg (118 to 150). After labetalol boluses, cerebral blood flow was unchanged at 769 ml/min (734 to 900; P = 0.68). CO increased to 6,413 ml/min (6,056 to 7,464; P = 0.03).

Conclusion: In healthy awake subjects, increasing MAP using intravenous noradrenaline decreased cerebral blood flow and CO. This data does not support inducing hypertension with noradrenaline to increase cerebral blood flow. Cerebral blood flow was unchanged when decreasing MAP using labetalol.

Place, publisher, year, edition, pages
Wolters Kluwer, 2024
National Category
Neurology Radiology, Nuclear Medicine and Medical Imaging Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-220047 (URN)10.1097/ALN.0000000000004775 (DOI)37756527 (PubMedID)2-s2.0-85187724522 (Scopus ID)
Funder
Region Västerbotten
Available from: 2024-01-26 Created: 2024-01-26 Last updated: 2024-04-08Bibliographically approved
Zarrinkoob, L., Myrnäs, S., Wåhlin, A., Eklund, A. & Malm, J. (2024). Cerebral blood flow patterns in patients with low-flow carotid artery stenosis, a 4D-PCMRI assessment. Journal of Magnetic Resonance Imaging
Open this publication in new window or tab >>Cerebral blood flow patterns in patients with low-flow carotid artery stenosis, a 4D-PCMRI assessment
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2024 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Compromised cerebral blood flow can contribute to future ischemic events in patients with symptomatic carotid artery disease. However, there is limited knowledge of the effects on cerebral hemodynamics resulting from a reduced internal carotid artery (ICA) blood flow rate (BFR).

Purpose: Investigate how reduced ICA-BFR, relates to BFR in the cerebral arteries.

Study Type: Prospective.

Subjects: Thirty-eight patients, age 72 ± 6 years (11 female).

Field Strength/Sequence: 3-Tesla, four-dimensional phase-contrast magnetic resonance imaging (4D-PCMRI).

Assessment: Patients with ischemic stroke or transient ischemic attack were evaluated regarding the degree of stenosis. 4D-PCMRI was used to measure cerebral BFR in 38 patients with symptomatic carotid stenosis (≥50%). BFR in the cerebral arteries was assessed in two subgroups based on symptomatic ICA-BFR: reduced ICA-flow (<160 mL/minutes) and preserved ICA-flow (≥160 mL/minutes). BFR laterality was defined as a difference in the paired ipsilateral-contralateral arteries.

Statistical Tests: Patients were grouped based on ICA-BFR (reduced vs. preserved). Statistical tests (independent sample t-test/paired t-test) were used to compare groups and hemispheres. Significance was determined at P < 0.05.

Results: The degree of stenosis was not significantly different, 80% (95% confidence interval [CI] = 73%–87%) in the reduced ICA-flow vs. 72% (CI = 66%–76%) in the preserved ICA-flow; P = 0.09. In the reduced ICA-flow group, a significantly reduced BFR was found in the ipsilateral middle cerebral artery and anterior cerebral artery (A1), while significantly increased in the contralateral A1. Retrograde BFR was found in the posterior communicating artery and ophthalmic artery. Significant BFR laterality was present in all paired arteries in the reduced ICA-flow group, contrasting the preserved ICA-flow group (P = 0.14–0.93).

Data Conclusions: 4D-PCMRI revealed compromised cerebral BFR due to carotid stenosis, not possible to detect by solely analyzing the degree of stenosis. In patients with reduced ICA-flow, collaterals were not sufficient to maintain symmetrical BFR distribution to the two hemispheres.

Evidence Level: 2.

Technical Efficacy: Stage 3.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
4D-PCMRI, cerebral blood flow, cerebrovascular disease, Circle of Willis, MRI, symptomatic carotid stenosis
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-219323 (URN)10.1002/jmri.29216 (DOI)001135005100001 ()38168876 (PubMedID)2-s2.0-85181227868 (Scopus ID)
Funder
Swedish Research Council, 2015-05616Swedish Research Council, 2017-04949Region VästerbottenSwedish Heart Lung Foundation, 20140592
Available from: 2024-01-15 Created: 2024-01-15 Last updated: 2024-01-15
Kihlstedt, C.-J., Malm, J., Fasano, A. & Bäckström, D. C. (2024). Freezing of gait in idiopathic normal pressure hydrocephalus. Fluids and Barriers of the CNS, 21(1), Article ID 22.
Open this publication in new window or tab >>Freezing of gait in idiopathic normal pressure hydrocephalus
2024 (English)In: Fluids and Barriers of the CNS, E-ISSN 2045-8118, Vol. 21, no 1, article id 22Article in journal (Refereed) Published
Abstract [en]

Background: Reports of freezing of gait (FoG) in idiopathic normal pressure hydrocephalus (iNPH) are few and results are variable. This study's objective was to evaluate the frequency of FoG in a large cohort of iNPH patients, identify FoG-associated factors, and assess FoG’s responsiveness to shunt surgery.

Methods: Videotaped standardized gait protocols with iNPH patients pre- and post-shunt surgery (n = 139; median age 75 (71–79) years; 48 women) were evaluated for FoG episodes by two observers (Cohens kappa = 0.9, p < 0.001). FoG episodes were categorized. Mini-mental state examination (MMSE) and MRI white matter hyperintensities (WMH) assessment using the Fazekas scale were performed. CSF was analyzed for Beta-amyloid, Tau, and Phospho-tau. Patients with and without FoG were compared.

Results: Twenty-two patients (16%) displayed FoG at baseline, decreasing to seven (8%) after CSF shunt surgery (p = 0.039). The symptom was most frequently exhibited during turning (n = 16, 73%). Patients displaying FoG were older (77.5 vs. 74.6 years; p = 0.029), had a slower walking speed (0.59 vs. 0.89 m/s; p < 0.001), a lower Tinetti POMA score (6.8 vs. 10.8; p < 0.001), lower MMSE score (21.3 vs. 24.0; p = 0.031), and longer disease duration (4.2 vs. 2.3 years; p < 0.001) compared to patients not displaying FoG. WMH or CSF biomarkers did not differ between the groups.

Conclusions: FoG is occurring frequently in iNPH patients and may be considered a typical feature of iNPH. FoG in iNPH was associated with higher age, longer disease duration, worse cognitive function, and a more unstable gait. Shunt surgery seems to improve the symptom.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Cerebrospinal fluid shunts, Gait disorders, Neurologic, Hydrocephalus, normal pressure, Parkinson disease, Parkinsonian disorders
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-222428 (URN)10.1186/s12987-024-00522-y (DOI)001181184300001 ()38454478 (PubMedID)2-s2.0-85187136335 (Scopus ID)
Available from: 2024-03-19 Created: 2024-03-19 Last updated: 2024-03-19Bibliographically approved
Eklund, S., Israelsson, H., Brunström, M., Forsberg, K. & Malm, J. (2023). 10-year mortality, causes of death and cardiovascular comorbidities in idiopathic normal pressure hydrocephalus. Journal of Neurology
Open this publication in new window or tab >>10-year mortality, causes of death and cardiovascular comorbidities in idiopathic normal pressure hydrocephalus
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2023 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: The objective was to investigate 10-year mortality, causes of death and cardiovascular comorbidity in idiopathic normal pressure hydrocephalus (iNPH) and to evaluate their mutual associations.

Methods: This prospective cohort study included 176 CSF-shunted iNPH patients, and 368 age- and sex-matched controls. At inclusion, participants were medically examined, had blood analyzed and answered a questionnaire. The vascular comorbidities investigated were smoking, diabetes, body mass index, blood pressure (BP), hyperlipidemia, kidney function, atrial fibrillation and, cerebro- and cardiovascular disease.

Results: Survival was observed for a mean period of 10.3 ± 0.84 years. Shunted iNPH patients had an increased risk of death compared to controls (hazard ratio (HR) = 2.5, 95% CI 1.86–3.36; p < 0.001). After 10 years, 50% (n = 88) of iNPH patients and 24% (n = 88) of the controls were dead (p < 0.001). The risk of dying from cardiovascular disease, falls and neurological diseases were higher in iNPH (p < 0.05). The most common cause of death in iNPH was cardiovascular diseases (14% vs 7% for controls). Seven out of nine iNPH dying from falls had subdural hematomas. Systolic BP (HR = 0.985 95% CI 0.972–0.997, p = 0.018), atrial fibrillation (HR = 2.652, 95% CI 1.506–4.872, p < 0.001) and creatinine (HR = 1.018, 95% CI 1.010–1.027, p < 0.001) were independently associated with mortality for iNPH.

Discussion: This long-term and population-matched cohort study indicates that in spite of CSF-shunt treatment, iNPH has shorter life expectancy. It may be important to treat iNPH in supplementary ways to reduce mortality. Both cardiovascular comorbidities and lethal falls are contributing to the excess mortality in iNPH and reducing these preventable risks should be an established part of the treatment plan.

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2023
Keywords
Cardiovascular disease, Causes of death, Comorbidities, Mortality, Normal pressure hydrocephalus
National Category
Neurology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-216638 (URN)10.1007/s00415-023-12067-5 (DOI)2-s2.0-85175579237 (Scopus ID)
Funder
Region Västerbotten
Available from: 2023-11-14 Created: 2023-11-14 Last updated: 2023-11-15
Hansson, W., Johansson, E., Birgander, R., Eklund, A. & Malm, J. (2023). Cerebral Microbleeds-Long-Term Outcome After Cerebrospinal Fluid Shunting in Idiopathic Normal Pressure Hydrocephalus. Neurosurgery, 93(2), 300-308
Open this publication in new window or tab >>Cerebral Microbleeds-Long-Term Outcome After Cerebrospinal Fluid Shunting in Idiopathic Normal Pressure Hydrocephalus
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2023 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 93, no 2, p. 300-308Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cerebral microbleeds (CMBs) are common in idiopathic normal pressure hydrocephalus (INPH) and have been suggested as radiological markers of a brain prone to bleeding. The presence of CMBs might be relevant when selecting patients for shunt surgery.

OBJECTIVE: To evaluate whether CMBs increases long-term risk of hemorrhagic complications and mortality or affects outcomes after cerebrospinal fluid shunt surgery in a cohort of patients with INPH.

METHODS: One hundred and forty nine shunted patients with INPH (mean age, 73 years) were investigated with MRI (T2* or susceptibility-weighted imaging sequences) preoperatively. CMBs were scored with the Microbleed Anatomic Rating Scale. Patients were observed for a mean of 6.5 years (range 2 weeks to 13 years) after surgery. Hemorrhagic events and death were noted. Improvement in gait was evaluated 3 to 6 months after surgery.

RESULTS: At baseline, 74 patients (50%) had CMBs. During follow-up, 7 patients (5%) suffered a hemorrhagic stroke and 43 (29%) suffered a subdural hematoma/hygroma with a median time from surgery of 30.2 months (IQR 50). Overall, having CMBs was not associated with suffering a subdural hematoma/hygroma or hemorrhagic stroke during follow-up with 1 exception that an extensive degree of CMBs (≥50 CMB) was more common in patients suffering a hemorrhagic stroke ( P = .03). CMBs were associated with increased mortality ( P = .02, Kaplan-Meier, log-rank test). The presence of CMBs did not affect gait outcome ( P = .28).

CONCLUSION: CMBs were associated with hemorrhagic stroke and mortality. CMBs do not seem to reduce the possibility of gait improvement after shunt surgery or contribute to the risk of hemorrhagic complications regarding subdural hematoma or hygroma.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-212403 (URN)10.1227/neu.0000000000002409 (DOI)36853021 (PubMedID)2-s2.0-85165222188 (Scopus ID)
Available from: 2023-07-28 Created: 2023-07-28 Last updated: 2023-07-28Bibliographically approved
Bluett, B., Ash, E., Farheen, A., Fasano, A., Krauss, J. K., Maranzano, A., . . . Martino, D. (2023). Clinical features of idiopathic normal pressure hydrocephalus: critical review of objective findings. Movement Disorders Clinical Practice, 10(1), 9-16
Open this publication in new window or tab >>Clinical features of idiopathic normal pressure hydrocephalus: critical review of objective findings
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2023 (English)In: Movement Disorders Clinical Practice, E-ISSN 2330-1619, Vol. 10, no 1, p. 9-16Article, review/survey (Refereed) Published
Abstract [en]

Background: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by the classic clinical triad of gait, cognitive, and urinary dysfunction, albeit incomplete in a relevant proportion of patients. The clinical findings and evolution of these symptoms have been variably defined in the literature.

Objectives: To evaluate how the phenomenology has been defined, assessed, and reported, we performed a critical review of the existing literature discussing the phenomenology of iNPH. The review also identified the instrumental tests most frequently used and the evolution of clinical and radiologic findings.

Methods: The review was divided into 3 sections based on gait, cognitive, and urinary dysfunction. Each section performed a literature search using the terms “idiopathic normal pressure hydrocephalus” (iNPH), with additional search terms used by each section separately. The number of articles screened, duplicates, those meeting the inclusion criteria, and the number of articles excluded were recorded. Findings were subsequently tallied and analyzed.

Results: A total of 1716 articles with the aforementioned search criteria were identified by the 3 groups. A total of 81 full-text articles were reviewed after the elimination of duplicates, articles that did not discuss phenomenological findings or instrumental testing of participants with iNPH prior to surgery, and articles with fewer than 10 participants.

Conclusions: “Wide-based gait” was the most common gait dysfunction identified. Cognitive testing varied significantly across articles, and ultimately a specific cognitive profile was not identified. Urodynamic testing found detrusor overactivity and “overactive bladder” as the most common symptom of urinary dysfunction.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
cognition, gait, normal pressure hydrocephalus, phenomenology, urination
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-201644 (URN)10.1002/mdc3.13608 (DOI)000888002200001 ()36704075 (PubMedID)2-s2.0-85142926926 (Scopus ID)
Available from: 2022-12-13 Created: 2022-12-13 Last updated: 2023-06-20Bibliographically approved
Luciano, M., Holubkov, R., Williams, M. A., Malm, J., Nagel, S., Moghekar, A., . . . Hamilton, M. G. (2023). Placebo-controlled effectiveness of idiopathic normal pressure hydrocephalus shunting: a randomized pilot trial. Neurosurgery, 92(3), 481-489
Open this publication in new window or tab >>Placebo-controlled effectiveness of idiopathic normal pressure hydrocephalus shunting: a randomized pilot trial
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2023 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 92, no 3, p. 481-489Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Multiple prospective nonrandomized studies have shown 60% to 70% of patients with idiopathic normal pressure hydrocephalus (iNPH) improve with shunt surgery, but multicenter placebo-controlled trial data are necessary to determine its effectiveness.

OBJECTIVE: To evaluate the effectiveness of cerebrospinal fluid shunting in iNPH through comparison of open vs placebo shunting groups at 4 months using a pilot study.

METHODS: Patients were randomized to a Codman Certas Plus valve (Integra LifeSciences) set at 4 (open shunt group) or 8 (“virtual off”; placebo group). Patients and assessors were blinded to treatment group. The primary outcome measure was 10-m gait velocity. Secondary outcome measures included functional scales for bladder control, activities of daily living, depression, and quality of life. Immediately after 4-month evaluation, all shunts were adjusted in a blinded fashion to an active setting and followed to 12 months after shunting.

RESULTS: A total of 18 patients were randomized. At the 4-month evaluation, gait velocity increased by 0.28 ± 0.28 m/s in the open shunt group vs 0.04 ± 0.17 m/s in the placebo group. The estimated treatment difference was 0.22 m/s ([P = .071], 95% CI −0.02 to 0.46). Overactive Bladder Short Form symptom bother questionnaire significantly improved in open shunt vs placebo (P = .007). The 4-month treatment delay did not reduce the subsequent response to active shunting, nor did it increase the adverse advents rate at 12 months.

CONCLUSION: This multicenter, randomized pilot study demonstrates the effectiveness, safety, and feasibility of a placebo-controlled trial in iNPH, and found a trend suggesting gait velocity improves more in the open shunt group than in the placebo group.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
Keywords
NPH (normal pressure hydrocephalus), Hydrocephalus, Shunting, RCT, Placebo, VPS (ventriculoperitoneal shunting)
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-202116 (URN)10.1227/neu.0000000000002225 (DOI)000936650300026 ()36700738 (PubMedID)2-s2.0-85148250280 (Scopus ID)
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-09-05Bibliographically approved
Eklund, S. A., Israelsson, H., Carlberg, B. & Malm, J. (2023). Vascular risk profiles for predicting outcome and long-term mortality in patients with idiopathic normal pressure hydrocephalus: comparison of clinical decision support tools. Journal of Neurosurgery, 138(2), 476-482
Open this publication in new window or tab >>Vascular risk profiles for predicting outcome and long-term mortality in patients with idiopathic normal pressure hydrocephalus: comparison of clinical decision support tools
2023 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 138, no 2, p. 476-482Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Vascular risk factors (VRFs) may act synergistically, and clinical decision support tools (CDSTs) have been developed that present vascular risk as a summarized score. Because VRFs are a major issue in patients with idiopathic normal pressure hydrocephalus (INPH), a CDST may be useful in the diagnostic workup. The objective was to compare 4 CDSTs to determine which one most accurately predicts short-term outcome and 10-year mortality after CSF shunt surgery in INPH patients.

METHODS: One-hundred forty INPH patients who underwent CSF shunt surgery were included. For each patient, 4 CDST scores (Systematic Coronary Risk Evaluation–Older Persons [SCORE-OP], Framingham Risk Score [FRS], Revised Framingham Stroke Risk Profile, and Kiefer’s Comorbidity Index [KCI]) were estimated. Short-term outcome (3 months after CSF shunt surgery) was defined on the basis of improvements in gait, Mini-Mental State Examination score, and modified Rankin Scale score. The 10-year mortality rate after surgery was noted. The CDSTs were compared by using Cox regression analysis, receiver operating characteristic curve analysis, and the chi-square test.

RESULTS: For 3 CDSTs, increased score was associated with increased risk of 10-year mortality. A 1-point increase in the FRS indicated a 2% higher risk of death within 10 years (HR 1.02, 95% CI 1.003–1.035, p = 0.021); SCORE-OP, 5% (HR 1.05, 95% CI 1.019–1.087, p = 0.002); and KCI, 12% (HR 1.12, 95% CI 1.03–1.219, p = 0.008). FRS predicted short-term outcome of surgery (p = 0.024). When the cutoff value was set to 32.5%, the positive predictive value was 80% and the negative predictive value was 48% (p = 0.012).

CONCLUSIONS: The authors recommend using FRS to predict short-term outcome and 10-year risk of mortality in INPH patients. The study indicated that extensive treatment of the risk factors of INPH may decrease risk of mortality.

Place, publisher, year, edition, pages
Journal of Neurosurgery Publishing Group (JNSPG), 2023
Keywords
INPH, vascular risk factors, mortality, CSF shunt surgery, clinical decision support tool, Framingham Risk Score, hydrocephalus, outcome
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-202118 (URN)10.3171/2022.4.jns22125 (DOI)000933582800005 ()35901765 (PubMedID)2-s2.0-85147296575 (Scopus ID)
Funder
Region VästerbottenUmeå University
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-09-05Bibliographically approved
Wåhlin, A., Eklund, A. & Malm, J. (2022). 4D flow MRI hemodynamic biomarkers for cerebrovascular diseases. Journal of Internal Medicine, 291(2), 115-127
Open this publication in new window or tab >>4D flow MRI hemodynamic biomarkers for cerebrovascular diseases
2022 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 291, no 2, p. 115-127Article, review/survey (Refereed) Published
Abstract [en]

Alterations in cerebral blood flow are common in several neurological diseases among the elderly including stroke, cerebral small vessel disease, vascular dementia, and Alzheimer's disease. 4D flow magnetic resonance imaging (MRI) is a relatively new technique to investigate cerebrovascular disease, and makes it possible to obtain time-resolved blood flow measurements of the entire cerebral arterial venous vasculature and can be used to derive a repertoire of hemodynamic biomarkers indicative of cerebrovascular health.

The information that can be obtained from one single 4D flow MRI scan allows both the investigation of aberrant flow patterns at a focal location in the vasculature as well as estimations of brain-wide disturbances in blood flow. Such focal and global hemodynamic biomarkers show the potential of being sensitive to impending cerebrovascular disease and disease progression and can also become useful during planning and follow-up of interventions aiming to restore a normal cerebral circulation.

Here, we describe 4D flow MRI approaches for analyzing the cerebral vasculature. We then survey key hemodynamic biomarkers that can be reliably assessed using the technique. Finally, we highlight cerebrovascular diseases where one or multiple hemodynamic biomarkers are of central interest.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
Alzheimer's disease, atherosclerosis, carotid stenosis, cerebral blood flow, collateral circulation, phase-contrast MRI, small-vessel disease, stroke
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-190012 (URN)10.1111/joim.13392 (DOI)000722268700001 ()34813112 (PubMedID)2-s2.0-85119704251 (Scopus ID)
Available from: 2021-12-01 Created: 2021-12-01 Last updated: 2022-07-06Bibliographically approved
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